Payer Relations & Success Specialist in at Senderra RX Pharmacy

Education / Licensing Requirements:

• High school diploma or equivalent and relevant healthcare administrative experience required.
• Associate or bachelor’s degree in business, healthcare administration or a related field preferred

• 2+ years of experience in payer relations, specialty pharmacy, PBM operations,
• healthcare customer success, insurance operations, claims support or provider/payer
• services. Experience supporting payer portals, credentialing, account administration or
• contract implementation is beneficial.

Position Overview:

The Payer Relations & Success Specialist supports day-to-day service and operational coordination for Senderra’s pharmacy benefit manager (PBM), health plan and payer partners. Under the direction of the Payer Relations & Success Manager, the Specialist tracks payer inquiries, supports contract and program implementation, maintains accurate account records, and coordinates timely resolution of access, reimbursement and reporting issues. The role helps deliver a responsive, consistent partner experience while protecting network participation and contractual commitments.

Essential Skills:

• Strong written and verbal communication skills
• Works well in team environment
• Proven time management and organizational skills
• Strong analytical skills
• Proven ability to prioritize and multi-task

Characteristics:

• Self-directed
• Flexible and proactive
• Sense of urgency
• Detail oriented; catches errors early
• Ethical; respects confidentiality

Responsibilities:

• Support assigned payer/PBM accounts by monitoring shared inboxes, responding to routine inquiries, maintaining payer contact records and meeting action logs, and escalating strategic or sensitive matters to the Manager.
• Coordinate routine payer service requests, track open issues and follow-ups, prepare meeting materials and status updates, and document resolutions to support payer satisfaction and account continuity.
• Assist with credentialing, recredentialing, enrollment, ownership-change notices, attestations and license/accreditation submissions; coordinate required documentation with the Payer Contracting & Credentialing Specialist to avoid duplication.
• Research claim rejections, reimbursement discrepancies, access restrictions and payer policy questions; gather claim, NDC, BIN/PCN/group and contract details and route pricing decisions, appeals or material risks for appropriate review.
• Support payer RFP/RFI responses and contract amendments by organizing requests, collecting approved supporting documents, tracking deadlines and maintaining current payer-facing capability materials.
• Maintain payer implementation and change-control checklists; verify payer identifiers, participating plans, covered drug lists, referral pathways, contact information and claims-testing follow-ups with operational owners.
• Track recurring payer reporting, performance guarantee deliverables, attestations and file submissions; coordinate with Reporting, IT and Payer Operations to investigate missing, late or inconsistent deliverables.
• Coordinate day-to-day resolution of payer and member-service escalations with Pharmacy Operations, Clinical, Finance and other teams; document root causes, ownership, due dates and outcomes, escalating unresolved issues promptly.
• Maintain accurate account files, payer correspondence, program requirements, portal information, trackers and quarterly business review materials; identify recurring issues and recommend practical workflow improvements.

Key Deliverables & Performance Expectations

• Timely acknowledgment, tracking and closure of payer inquiries and escalations, with overdue items escalated.
• Accurate, current payer contact lists, account trackers and implementation documentation.
• On-time coordination of assigned reporting, attestations, enrollment and program deliverables.
• Complete meeting agendas, action logs, follow-up communications and business-review support.
• Consistent documentation of claim/access issues and cross-functional resolutions.
• Specific targets and service-level expectations are established by management.

Working Conditions:

• Fast-paced environment.
• Requires normal vision (corrected) both close and distant.
• Requires normal hearing levels (corrected).
• Requires working at a desk to use a phone and computer for extended periods of time. Requires sitting, bending.
• Uses office equipment and machinery effectively.
• Requires normal finger dexterity for keyboarding.
• Works effectively with frequent interruptions.
• Minimal travel <5%.