Customer Care Associate I

About the role

Prime Therapeutics (Prime) is a purpose-driven PBM connecting care for those we serve. The Customer Care Specialist provides support to members and providers by addressing inquiries related to eligibility, benefits, claims, and service authorizations. The role involves handling incoming and outbound calls, documenting intake information, and delivering outstanding customer service to internal and external stakeholders. The goal is to resolve member and provider needs efficiently, ideally on the first call, while meeting or exceeding performance standards for quality and productivity.

Responsibilities

• Engage inbound callers professionally; actively listen and probe to determine the purpose of the call and resolve administrative concerns, including claims and dissatisfaction
• Make outbound calls to resolve member issues (e.g., billing issues with a Pharmacy) or obtain additional information needed for a prior authorization
• Research and communicate member information such as eligibility, benefits, Employee Assistance Program (EAP) services, claims, and authorizations while maintaining confidentiality
• Initiate care programs by accurately assembling and entering patient data into appropriate systems for EAP, Care, and Utilization Management
• Educate providers and members on claims submission, treatment plans, appeal processes, and reimbursement rates across multiple networks
• Identify and respond to crisis calls, assisting clinicians until resolution; make routine referrals and triage decisions not requiring clinical judgment
• Support continuous improvement by identifying operational inefficiencies, performing follow-up tasks, and ensuring member/provider needs are fully met
• Document interactions thoroughly; forward necessary information to appropriate staff and refer provider-related inquiries to the correct teams
• Perform other duties as assigned

Minimum Qualifications

• High school diploma from an accredited school or GED
• Eligibility to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Flexibility in scheduling and comfort with change
• Proficient typist (average 35+ WPM) with strong written and verbal communication skills
• Demonstrated ability to multitask and navigate various computer platforms while verifying information on all calls
• Ability to thrive in high-volume call center environments, managing a large number of inbound and outbound calls efficiently
• Familiarity with medical terminology, healthcare procedures, and insurance-related language to effectively support member and provider inquiries
• Knowledge of HIPAA regulations and other healthcare compliance standards

Preferred Qualifications

• Prior experience in a healthcare or insurance call center environment
• Previous customer service experience
• Previous experience with Genesys and CRM technology platforms

Every employee must understand, comply with, and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures. Every employee must be able to perform the essential functions of the job, and reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship.

Pay

Potential pay for this position ranges from $17.85 to $25.48 based on experience and skills.