Job Description
SUMMARY: Performs a variety of functions related to pharmacy benefit management support including but not limited to provider support and client and member prescription claim processing services.Functions as a first line resource in providing customer support for prescription benefit services primarily through phone, fax, and email.
PRINCIPLE RESPONSIBILITIES includes but are not limited to: - Answers incoming telephone calls related to pharmacy provider support or member benefit coverage determinations using established protocols and plan rules.
- Reviews 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.
- Enrolls new members and/or processes terminations as needed.
- Maintains pharmacy call log summary.
- Performs transaction overrides as required and approved by client groups.Maintains complete documentation of formulary overrides in proper notes section of member profiles.
- Develops automated reference materials (intranet access) of updated plan information.
- Serves 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.
- Assists with the implementation, QA, plan review, and claims unit testing of new plans and any client group wide change as needed.
- Performs various related duties as assigned including but not limited to Pharmacy Network updates; Pharmacy direct member reimbursements; ID card management and distribution; etc.
SKILLS AND REQUIREMENTS: - Education:
- High school diploma or equivalent required, post high school education preferred.
- Specialized training as a Certified Pharmacy Technician preferred.
- Experience:
- 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.
ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at
(678) 248-4755 or email us at HR@procarerx.com.
ProCare Rx is an Equal Opportunity Employer.
Job Tags
Work experience placement, Flexible hours, Weekend work, Weekday work,