Operations Representative - Medicaid

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

HCSC is looking for an individual to join its Medicaid Pharmacy Operations team. The role provides assistance to pharmacists, pharmacy team, care coordinators, and the customer service team in resolving pharmacy‑related issues, including claims. You will work closely with internal departments and external vendors to evaluate and resolve issues, support processes to ensure federal and state regulations and program requirements are met, and communicate pharmacy‑related written and telephone inquiries with members, providers, pharmacies, and groups regarding benefits.

The role requires working in the Albuquerque office at least three days a week, with up to two days of remote work. Core business hours are 8:00 AM – 5:00 PM MST Monday‑Friday.

• Certified Pharmacy Technician – current CPhT.
• Bachelor's degree in Business or a related health‑care field, or four years of work experience in a pharmacy, health‑care, or managed care industry.
• Verbal and written communication skills.
• Managed care customer service experience.
• Proficiency in MS Office suite (Word, Excel, Access) and database software.
• Drug information skills.
• Ability to handle multiple tasks and strong organizational skills.

• Experience in retail, hospital, specialty pharmacy, pharmacy benefits management, or health‑plan environments.
• Telephone support experience with members, providers, pharmacies, and groups regarding benefits.
• Support via written and digital channels.
• Collaborating with internal stakeholders to resolve pharmacy‑related gaps in care, coverage, and claims submission issues.
• Facilitating process for clinical and benefit overrides, step‑therapy, and prior‑authorization efforts in PBM claims systems for utilization management and clinical services.
• Availability during core business hours Monday‑Friday 8:00 AM – 5:00 PM MST and commute to Albuquerque, NM office.

This is a hybrid role for the Albuquerque, New Mexico office. The role requires you to work in the Albuquerque office at least three days a week, with up to two days of remote work. Core business hours are 8:00 AM – 5:00 PM MST Monday‑Friday.

Compensation: $38,100.00 – $80,000.00. Exact compensation may vary based on skills, experience, and location.

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please visit