Pharmacy Customer Service Representative Location Gainesville, GA : 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 or email us at . ProCare Rx is an Equal Opportunity Employer.
