Pharmacy Benefits Specialist I

Job Description:

The Pharmacy Benefit Specialist I is responsible for the day-to-day operations of Commercial programs, providing superior customer service to all inquiries and questions for members, providers, employer groups, facilities, brokers and other departments and teams. This position provides superior customer service consistent with policies, company values, and quality standards. The incumbent resolves customer issues on the initial call or provides timely follow-up when additional research is needed. This position complies with established criteria for response time, handling time, availability, and call flow as well as established auditing criteria. The Benefit Specialist I stays current and conversant on general plan design and modifications to provide accurate and appropriate information. This position maintains the confidentiality of member's personal information to be compliant with internal confidentiality policy. The incumbent maintains customer history in member tracking using correct codes and detailed comments. This position educates callers on correct use of their plans including coverage of benefits, utilization, and administrative guidelines in collaboration with teammates and other departments.

• Processes and/or communicates multiple types of pharmacy benefits including coordination of benefits, direct member reimbursements, coinsurance benefits, and mail order prescriptions.
• Makes exceptions/empowerment decisions within the established exception policy.
• Consistently demonstrates excellent customer service skills including problem solving, telephone etiquette, and responsiveness to customers.
• Ensures that all department standards and expectations are met pertaining to call statistics, production, documentation, and quality/accuracy.
• Efficiently and quickly addresses and solves problems.
• Meets or exceeds department standards, including but not limited to; call handling time, adherence, calls answered, phone and override auditing standards.
• Meets or exceeds presence code standards for the department.
• Completes and analyzes specialized reports that are used to ensure timely and accurate claims adjudication.
• Works closely with operations and pharmacy teams to communicate issues and resolve problems.

Minimum Qualifications

Demonstrated experience in any of the following:

• Medical/pharmacy claims processing.
• Health benefit coordination.
• Customer service.
• Pharmacy technician.
• Basic proficiency in navigating systems, typing and technologies.
• Experience problem solving and working under pressure.

Preferred Qualifications

• Current National Pharmacy Technician certification
• Call center experience
• Bilingual in English and Spanish

Skills

• Pharmacy
• Pharmacy Benefits Management (PBM)
• Medical Prescriptions
• Pharmacy Claims
• Call Center
• Customer Service
• Problem Resolution
• Phone Calls (Inbound/Outbound)
• Oral Communication
• Written Communication
• Group Problem Solving
• Typing

Physical Requirements:

Physical Requirements

• Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with providers, colleagues, customers, patients/clients and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$ $30.81

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.