Claims Configuration Jobs in Wisconsin (NOW HIRING)

Do you have a passion for providing exceptional customer experience? Do you have an interest in improving the health of others by collaborating with team members to solve problems that support the needs of our customers?  

If so, please consider applying to one of the Pharmacy Specialist positions! Quartz is looking for an organized, adaptable individual to work as a Pharmacy Specialist.  We will be hiring two pharmacy specialist that will support our government program operations and formulary support teams within our pharmacy management department. 

Pharmacy Specialist, Government Program Operations will support the day-to-day operational management of Quartz's pharmacy benefits by administering pharmacy programs, implementing operational policies and procedures, and collaborating with internal teams to ensure accurate benefit administration and regulatory compliance.

Pharmacy Specialist, Formulary Support will support the development, implementation, and ongoing maintenance of Quartz's pharmacy formularies by coordinating formulary updates, assisting with coverage determinations, and ensuring accurate benefit configuration while also promoting a safe and effective pharmacy benefit management while supporting quality patient care and an exceptional member experience.

Benefits:  

• No WEEKENDS – Varying shifts between the hours of operation of 7:30am – 5pm, Monday – Friday 
• Opportunities for learning new skills and advancement 
• Starting pay range: $20.72-$25.91 /hr. based on skills and experience + robust total rewards package.

Pharmacy Specialist, Government Program Operations Role:

• Oversee the administration and implementation of pharmacy benefit programs, P&T Committee decisions, and benefit changes, including maintenance and updating of the formulary database, ensuring that medication lists are current and reflect the latest clinical guidelines and policy changes, and review/approval of testing by PBM and other vendors.
• Review pharmacy claims for accuracy, ensuring compliance with benefits policy guidelines and formulary requirements and internal teams
• Resolve claim discrepancies and issues by collaborating with pharmacy benefit managers (PBMs), healthcare providers and internal teams.
• Support development and maintenance of policies and procedures (P&Ps) and standard operating procedures (SOPs) that govern the Quartz pharmacy team and their activities.
• Coordinate with external vendors and partners to streamline pharmacy services and resolve operational challenges, ensuring high-quality service delivery.
• Respond to inquiries from Quartz staff, healthcare providers and members regarding formulary details, medication coverage, and benefit-related questions.

Pharmacy Specialist, Formulary Support Role:

• Draft, format, and maintain prior authorization, step‑therapy, and quantity‑limit criteria under pharmacist direction, ensuring they are clear, implementable, and aligned with regulatory/contract requirements for all lines of business
  • Includes: Commercial, Medicare, Medicaid, Exchange.
• Translate approved policies into system‑ready rules and decision trees for prior authorization and claims platforms, partnering with IT/Benefit Configuration/PBM resources to test and validate configurations.
• Support formulary and medical benefit drug coverage management by preparing formulary change grids, updating drug dictionaries and coverage notes, and tracking non formulary and exception trends for pharmacist reviews.
• Perform regulatory plan document reviews as a pharmacy benefit Subject Matter Expert (SME) for formulary and Pharmacy & Therapeutics related activities.
• Assist in change-notification processes and ongoing file maintenance to uphold accuracy and operational efficiency.

• High School Diploma or equivalency is required.
• 2+ years previous experience in a health care setting, managed care, PBM, or pharmacy setting is required.
• Knowledge of contracts, applications, products, and regulations (Medicare, ACA, Commercial).
• Knowledge of benefit systems and claims processing systems.
• Strong interest in clinical and operational pharmacy services excellence.
• Familiar with clinical program components, formulary designs, and prescription drug benefit trends.
• Able to demonstrate skills in prioritization, problem solving & critical thinking, team building, decision making, time management and strategic planning.
• Knowledge of external pharmacy related quality and performance metrics.
• Excellent organizational and interpersonal skills.
• Certified Pharmacy Technician (CPHT) or obtain CPHT within 12 months of hire.
• Pharmacy Technician license in state of residence.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. Quartz is a federal contractor and supports a safe, drug-free workplace. All employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.