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Operations Team Member at Rightway - ApplyBlast

Operations Team Member

Rightway

26 days ago

3.5 on Glassdoor

Remote

Full Time

Junior

1 applicant

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About this role

This role serves as the primary point of contact for members, providers, and pharmacies, resolving inquiries related to benefits, prior authorizations, claims, and clinical program enrollment across phone, chat, and email channels. The position requires applying empathy and root cause problem-solving to deliver timely support while utilizing AI-enabled tools and internal knowledge systems. The role involves coordinating with internal teams to ensure complete resolution of issues and documenting interactions to support continuity of care and compliance.

Responsibilities

Serve as primary point of contact for members, providers, and pharmacies across multiple communication channels
Resolve inquiries related to mail order, benefit design, formulary coverage, and prior authorization criteria
Assist network pharmacies in processing prescription claims and reviewing claims for accuracy against benefit guidelines

Skills

Qualifications

National Pharmacy Technician Certification (PTCB, NHA)

About Rightway

rightwayhealthcare.com

Headquarters

New York, New York, United States

Company Size

201-500 employees

Founded

2017

View Profile

Rightway Healthcare is a technology-enabled clinical care navigation and benefits company that helps employers and health plans connect members with high-quality, cost-effective care. It pairs clinician-led navigation with a transparent, outcomes-focused pharmacy benefits management (PBM) offering to simplify access, reduce unnecessary spend, and improve medication and treatment decisions. Rightway’s platform combines data-driven insights, care teams, and digital tools to personalize guidance, coordinate referrals, and drive better clinical and financial outcomes.