Pharmacy Customer Associate II

Elevance Health•Atlanta, FL

19h•Onsite

About The Position

BioPlus Specialty Pharmacy, a member of the Elevance Health family, offers unparalleled service focused on whole health through clinical expertise, digital capabilities, and broad access to specialty medications. The Pharmacy Customer Associate II responds to moderately complex customer questions via telephone and written correspondence regarding pharmacy retail and mail order prescriptions. This role requires a strong foundation in healthcare coverage analysis, claims processing, and clear communication. The associate will develop and maintain positive customer relations, interact with various internal and external customers for claims, customer service, and membership support, and respond to client issues regarding insurance benefits, contracts, eligibility, and claims. Proficiency in adjudicating claims through Pharmacy Benefit Managers (PBMs) is essential, along with the ability to accurately read, interpret, and troubleshoot claims. The role involves researching and interpreting medical and pharmacy benefit plans, understanding benefit structures, and displaying ownership of service requests to ensure high-quality resolution. Associates will support customers with their options and decisions, guiding them on using available technology, tools, and resources. The position requires the ability to multi-task, handling calls, texts, facsimiles, and electronic queues simultaneously while taking notes and speaking with customers. Working knowledge of pharmacy and medical terminology, and the ability to interpret prescriptions, including selecting appropriate dosing and units based on day supply requirements, is necessary. Strong attention to detail, the ability to analyze complex information, identify discrepancies, and ensure accurate benefit determination are key. Excellent written and verbal communication skills are required to document assessments and convey benefit information effectively. Additional expectations include maintaining focus during extended periods of sitting, handling multiple tasks in a fast-paced, high-pressure environment, strong verbal and written communication skills for virtual and in-person interactions, attentiveness to detail, critical thinking, problem-solving, and demonstrating empathy and persistence to resolve caller issues completely. Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts are also expected. Associates will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary. Other duties as assigned.

Requirements

Requires a HS diploma or equivalent and a minimum of 1 year of the company's experience in an automated customer service environment; or any combination of education and experience which would provide an equivalent background.
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Nice To Haves

General knowledge of company pharmacy services, products, insurance benefits, contracts and claims preferred.

Responsibilities

Develops and maintains positive customer relations and coordinates with functions within the company to ensure customer requests are handled and resolved appropriately and in a timely manner.
Interacts with internal and external customers (could include subscribers, providers, group or benefit administrators, physician offices, third party representatives, and other Blue Cross Plans) to provide claims, customer service, and/or membership support.
Responds to client issues via telephone and written correspondence regarding insurance benefits member, provider contracts, eligibility, claims, etc.
Proficiency in adjudicating claims through Pharmacy Benefit Managers (PBMs), with the ability to accurately read, interpret, and troubleshoot both paid and rejected claims.
Completes necessary research to provide proactive, thorough solutions.
Ability to research and interpret both medical and pharmacy benefit plans, including a comprehensive understanding of benefit structures such as copays, coinsurance, deductibles, out-of-pocket maximums, and coordination of benefits.
Displays ownership of service requests ensuring high quality resolution and follow-through.
Supports and guides the customer with their personal options and decisions and helps the customer become knowledgeable and confident about using technology, tools and resources available to them.
Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
Working knowledge of pharmacy and medical terminology and the ability to interpret prescriptions, including selecting appropriate dosing and units based on day supply requirements.
Strong attention to detail with the ability to analyze complex information, identify discrepancies, and ensure accurate benefit determination.
Excellent written and verbal communication skills to clearly document assessments and effectively convey benefit information to internal and external stakeholders.
Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
Performs other duties as assigned.