Customer Service - Pharmacy Technical Support Specialist 105-1073

Job Summary

Responsible for providing technical and customer service support for pharmacy benefits, processing prior authorizations according to CMS and State regulations, and resolving pharmacy related complaints.

Key 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.
• Processes prior authorizations for medications.
• May require overtime to meet deadlines.
• May involve dealing with members who are disgruntled or upset.
• Performs other job-related duties as assigned.

Qualifications

• 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.

Education/Experience

• 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.
• Previous customer service experience in a Medicare Advantage plan preferred.