Pharmacy Benefit Representative

2 weeks ago


Southfield, United States ProCare Rx Full time

SUMMARYPharmacy Benefit Representative performs a variety of functions related to workers' compensation claims and personal injury protection claims; i.e. the prescription, DMEPOS and ancillary benefits. Representative supports various claim processing services including handling client and member inquiries and problem resolutions, performing duties associated with claim adjudication and billing.Functions as a primary resource in providing customer support for injury claim clients and services.PRINCIPLE RESPONSIBILITIES include but are not limited to:Support multiple client program offeringsHandling general client inquiries, service calls, and problem resolution, meeting EHIM's performance standardsEffectively communicate with multiple parties to complete tasks from beginning to endPerforms benefit authorizations and modification as required and approved by clientMaintain up to date documentation of communications and activities between EHIM and client and/or member through EHIM system and operationsProactively keeps themselves and the department educated on industry trends and developments to accurately communicate to clientsPerforms various related duties and special projects as assignedFollows all policies and procedures related to job responsibilitiesSKILLS AND REQUIREMENTSHigh school diploma or equivalent required, post high school education preferred.Minimum two years' experience in a customer service position.Work experience as a pharmacy technician, DMEPOS provider, claims adjuster, or a similar service position in health care or injury claim industry is preferred.Must have excellent communication skills and the ability to work effectively with clients, pharmacies, vendors, and plan members.Proficient PC skills in Windows-based applications.Possess strong analytical skills and independent thinking/creativity.Ability to be flexible and quickly adapt to changing needs within the department.Must be highly organized with strong attention to detail.Must be flexible with scheduled work hours.Ability to work under general direction, on multiple tasks with demanding timelines.Managed care background and knowledge of pharmacy terminology desired.PHYSICAL DEMANDSRequires sitting, standing, and occasional light lifting



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