Pharmacy Call Center Representative
2 days ago
We are seeking a highly skilled and customer-focused Pharmacy Call Center Representative to join our team. As a key member of our pharmacy benefit management support team, you will be responsible for providing exceptional customer service to our clients, pharmacies, and plan members.
Key Responsibilities:
- Answer incoming telephone calls related to pharmacy provider support or member benefit coverage determinations using established protocols and plan rules.
- Review daily claim rejections and reference codes to determine if follow-up with Pharmacy/Member is required and will follow up with pharmacy/member as needed for claim resolution.
- Enroll new members and/or process terminations as needed.
- Maintain pharmacy call log summary.
- Perform transaction overrides as required and approved by client groups. Maintain complete documentation of formulary overrides in proper notes section of member profiles.
- Develop automated reference materials (intranet access) of updated plan information.
- Serve as Training Facilitator for new recruits in the pharmacy call center.
- Voluntary participation in on-call rotation covering one weekday evening and a weekend shift on an alternate rotation basis.
- Assist with the implementation, QA, plan review, and claims unit testing of new plans and any client group wide change as needed.
- Perform various related duties as assigned including but not limited to Pharmacy Network updates; Pharmacy direct member reimbursements; ID card management and distribution; etc.
Requirements:
- High school diploma or equivalent required, post high school education preferred.
- Specialized training as a Certified Pharmacy Technician preferred.
- Minimum two years experience in a customer service position, preferably in a call center environment.
- Work experience as a pharmacy technician or a similar service position in the health care industry is a strong plus.
- Must have strong customer service orientation and excellent communication skills, and the ability to work effectively with clients, pharmacies and plan members.
- Proficient PC skills in Windows-based applications.
- Health insurance background and knowledge of pharmacy terminology desired.
- Ability to be flexible and quickly adapt to the changing needs in the department.
- Must be highly organized with strong attention to detail.
- Must be flexible with scheduled work hours.
- Must be willing to provide pharmacy on-call support and coverage on a rotational basis.
Physical Demands:
Requires sitting, standing and occasional light lifting.
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