Customer Service - Pharmacy Technical Support Specialist 105-1073
About The Position
This role is responsible for providing technical and customer service support related to pharmacy benefits. Key duties include processing prior authorizations in compliance with CMS and State regulations, and resolving pharmacy-related complaints. The specialist will offer telephone support to pharmacies and members regarding HMO product pharmacy benefits, address various phone inquiries such as referrals, authorizations, and step therapy protocols, and resolve claims adjudication issues. The position also involves processing medication prior authorizations and may require overtime to meet deadlines, potentially involving interactions with disgruntled members.
Requirements
- Basic punctuation and grammar skills
- Ability to function under pressure.
- Proficient in Microsoft applications.
- Ability to work independently and apply good judgment.
- Ability to maintain and preserve information of highly confidential nature.
- Possess strong oral and written communication skills.
- Capable of project management from beginning to completion.
- Successful completion of Health Care Sanctions background check.
- High school diploma or equivalent.
- Two years’ experience in managed care pharmacy benefits, pharmacy tech or related discipline.
- Basic understanding of Health Plan Industry.
- One year customer service experience required.
Nice To Haves
- Previous customer service experience in a Medicare Advantage plan preferred.
Responsibilities
- Telephone support for pharmacies and members related to pharmacy benefits for the HMO product.
- Provides resolution for various types of phone calls including, but not limited to referral, authorization, and step therapy protocols between physicians, pharmacies and members for the HMO product.
- Resolve claims adjudication issues related to pharmacy.
- Responsible for processing prior authorizations for medications.
- Work may require overtime to meet deadlines.
- Work may also involve dealing with members who are disgruntled or upset.
- Performs other job-related duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
101-250 employees
