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ABOUT THE ROLE:
Rightway exists to make pharmacy benefits fair, transparent, and easier to navigate. This role sits on the Rightway Operations team and is a member of the front line of that mission: the first point of contact for members, providers, and pharmacies with questions about benefits, prior authorization, claims, and clinical program enrollment. You'll work across phone, chat, and email applying the same standard of empathy and root cause problem solving no matter the channel a member chooses.
WHAT YOU’LL DO:
Serve as the primary point of contact for members, providers, and pharmacies across phone, chat, email, and written correspondence, delivering timely and accurate support regardless of communication channel.
Field and resolve inquiries related to mail order, benefit design, formulary coverage, medication cost, prior authorization criteria, and claims adjudication.
Seamlessly support interactions across phone, chat, email, and other digital channels while maintaining consistent quality and service standards.
Assist network pharmacies in processing prescription claims, reviewing claims for accuracy against benefit guidelines and contract standards.
Support clinical pharmacists with patient and provider outreach, including scheduling appointments, enrolling members in Rightway clinical programs, and following up on medication adherence.
Accurately document interactions and resolutions within internal systems to support continuity of care, quality assurance, compliance requirements, and operational reporting.
Take ownership of member, provider, and pharmacy issues from initial contact through final resolution, coordinating with internal teams when necessary to ensure timely and complete resolution.
Utilize AI-enabled tools and internal knowledge systems to efficiently resolve inquiries, document interactions, and deliver a consistent member experience.
Foster a team environment that values cooperation, respect, and diversity, and take on other duties and projects as assigned.
WHO YOU ARE:
Bilingual in English/Spanish
Education: associate's or bachelor's degree preferred, or equivalent relevant work experience.
Certification: Active/Current National Pharmacy Technician Certification (PTCB, NHA)
Experience: 1 to 3 years as a pharmacy technician in a health plan, retail pharmacy setting, TPA, or PBM contact center role. Mail order and specialty pharmacy backgrounds are also a strong fit.
Working knowledge of pharmacy claims adjudication, benefit design, and PBM terminology.
Detail oriented, adaptable, and analytical, with the ability to dig past a symptom to find and resolve the true root cause.
Empathetic and intellectually curious, with a genuine desire to improve a member's healthcare experience and deliver concierge level service across every channel.
Comfortable multitasking and prioritizing across concurrent phone, chat, and email queues, with the independence to manage your own workload.
Comfortable supporting multiple lines of business and shifting priorities based on business needs, seasonal demand, and service levels.
COMPENSATION: $23.00/hr Compensation offered will be determined by geographic location, experience, and qualifications.
CYBERSECURITY AWARENESS NOTICE
In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @ email domain. We will never ask for bank details or deposits of any kind as a condition of employment.
ABOUT RIGHTWAY:
Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.
Since its founding in 2017, Rightway has raised over $200mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global. We’re headquartered in New York City, with satellite offices in Denver and Dallas. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.
HOW WE LIVE OUR VALUES TO OUR TEAMMATES:
We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our core values:
We are human, first Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.
We redefine what is possible We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.
We debate then commit We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.
We cultivate grit Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.
We seek to delight Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success.
Rightway is proud to be an Equal Opportunity Employer that believes in the strength of diverse thought, beliefs, backgrounds, and education. We foster an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis protected by applicable law. All employment decisions are based on merit, qualifications, need, and performance.