Care Manager

TEKsystems•Dallas, TX

2d•$21 - $21•Remote

About The Position

Role Summary Care Managers conduct high‑volume outbound calls to payors/pharmacy benefit managers (PBMs) to determine whether commercially insured patients on supported products are eligible for copay support. This role is phone‑intensive (up to 95% of the shift on calls), requires disciplined use of approved call guides, precise documentation in our systems, and professional customer service on recorded lines. There is no patient or caregiver interaction in this role. Essential Duties & Responsibilities • Make outbound PBM/payor calls for copay eligibility throughout the workday; maintain phone engagement up to 95% of the shift while executing the correct outbound campaigns and dispositions. • Follow approved Call Guides to ask structured, plan‑identifying questions of PBM agents; use compliant script/verbiage and payor‑call steps. • Determine and record the verified plan type: Traditional, Accumulator, Hybrid Accumulator, Maximizer, or Hybrid Maximizer, etc. using program definitions and SOPs. • Use PBM‑specific prompts (e.g., BIN/PCN/Group workflows, NPI handling, maximizer screening questions) to obtain the benefit details needed for eligibility determination. • Document every interaction accurately and in real time: complete call‑guide fields, outcomes, and notes in the designated CRM/telephony tools before taking/making the next call. • Create and manage follow‑up activities/tasks as needed with timely completion. • Maintain availability/status discipline in the telephony platform (Available/Ready, appropriate Away Codes, correct outbound campaign selection) to maximize connect time. • Adhere to program compliance and quality standards (privacy, script adherence, recorded‑call protocols) and participate in QA monitoring. • Collaborate professionally with payor/PBM contacts and internal teams; route inquiries outside program scope through approved channels. Customer Service & Conduct • Demonstrate courtesy, respect, empathy, and a service‑first mindset on every payor/PBM interaction. • Apply active listening and de‑escalation techniques with agents as needed. • Uphold workplace conduct guidelines and use only approved systems/channels for communications and documentation.

Requirements

High‑volume outbound call center experience (PBM/payor calling preferred); comfort with phone‑based work for the majority of the shift.
Familiarity with pharmacy benefit verification and PBM processes; ability to identify and document the plan types listed above using call‑guide prompts.
Computer proficiency: CRM/telephony tools, accurate typing, structured note‑taking, and data entry.
Strong listening, questioning, and problem‑solving skills; ability to follow SOPs and escalate internally when payor information is incomplete or conflicting.
Professional verbal communication; consistent, courteous demeanor on recorded lines.
High School Diploma or equivalent (some college preferred).
Call Center Experience: o Minimum 1–2 years in a high volume call center environment
Insurance Verification / Pharmacy Benefits: o At least 1 year experience in insurance verification, pharmacy benefit investigation, or related healthcare services (medical billing, prior authorization support).
High School Diploma or equivalent, some college preferred
Minimum 6 months to one year experience in medical billing, insurance verification, or similar related medical office experience
Previous data entry experience (minimum three months) and ability to type 30wpm+
Able to demonstrate high attention to detail in work
Must be computer savvy, to include navigating multiple computer tabs, monitors and applications
Advanced ability/knowledge of all Microsoft Suite programs (Teams, Word, Excel, Outlook, etc) and soft phone systems (WebEx, Mitel, Shoretel, etc.)
Exceptional communication skills, both written and verbal
Able to work in a virtual team environment by being available and responsive during working hours
Excellent follow through
This is a remote position. Employees must have a private workspace free of distraction to adhere to HIPAA compliance/guidelines. Workspace must include internet plug-in accessibility. Wi-fi connectivity is not permitted.
A working cell phone is required for 2 step authentication verifications during the length of the assignment.

Nice To Haves

Familiarity with PBM processes, copay assistance programs, and benefit plan types (Traditional, Accumulator, Maximizer).

Responsibilities

Make outbound PBM/payor calls for copay eligibility throughout the workday; maintain phone engagement up to 95% of the shift while executing the correct outbound campaigns and dispositions.
Follow approved Call Guides to ask structured, plan‑identifying questions of PBM agents; use compliant script/verbiage and payor‑call steps.
Determine and record the verified plan type: Traditional, Accumulator, Hybrid Accumulator, Maximizer, or Hybrid Maximizer, etc. using program definitions and SOPs.
Use PBM‑specific prompts (e.g., BIN/PCN/Group workflows, NPI handling, maximizer screening questions) to obtain the benefit details needed for eligibility determination.
Document every interaction accurately and in real time: complete call‑guide fields, outcomes, and notes in the designated CRM/telephony tools before taking/making the next call.
Create and manage follow‑up activities/tasks as needed with timely completion.
Maintain availability/status discipline in the telephony platform (Available/Ready, appropriate Away Codes, correct outbound campaign selection) to maximize connect time.
Adhere to program compliance and quality standards (privacy, script adherence, recorded‑call protocols) and participate in QA monitoring.
Collaborate professionally with payor/PBM contacts and internal teams; route inquiries outside program scope through approved channels.
Demonstrate courtesy, respect, empathy, and a service‑first mindset on every payor/PBM interaction.
Apply active listening and de‑escalation techniques with agents as needed.
Uphold workplace conduct guidelines and use only approved systems/channels for communications and documentation.