Pharmacy Technician

Job Responsibilities

• Maintain HIPAA/PHI guidelines to ensure the confidentiality of all calls and documents
• Interpret plan documents/plan guidelines
• Determine eligibility by reviewing, researching, and analyzing information in the appropriate system
• Use critical thinking and reasoning to manage workload with above average level
• Maintain and enter information into systems as information is received
• Forward all records to the appropriate parties
• Record and respond to calls/emails/faxes from Member, Providers, and Pharmacies
• Maintain high level of knowledge to answer specific Pharmacy Plan Benefit information or sharing guideline related questions
• Review issues as they arise
• Serve as a role model in demonstrating core values of customer service
• Provide timely and thorough responses to internal and external customers
• Escalate difficult issues to the appropriate party
• Provide exceptional customer service for incoming/outgoing calls
• Propose process improvements to enhance customer service satisfaction
• Ensure compliance with service standards
• Develop and execute plans to meet established goals
• Provide continuous feedback to strengthen and optimize quality performance
• Work cross-departmentally to improve or streamline procedures
• Maintain up to date knowledge on industry trends and look for new data sources
• Develop or improve current internal processes to improve overall quality
• Accurate and complete documentation of all daily interactions
• Special projects as assigned

Skills and Abilities

• Excellent verbal and written communication skills with high attention to detail
• Excellent customer service skills
• Strong analytical and problem-solving skills
• Confident decision-making abilities

Education and Experience

• High school diploma or equivalent required
• PBM Experience
• Minimum 2 years customer service or claims experience in the Health Insurance Industry
• Preferred experience in Call Center Customer Service
• Preferred experience in Pharmacy Tech
• Must have experience in handling multi-line telecommunication systems and electronic documentation software
• Knowledge of medical/pharmaceutical terminology required
• Health Insurance/Eligibility and Benefit knowledge required
• Prior authorization experience preferred
• Bilingual a plus

Physical Requirements

• Indoor office environment with moderate noise
• Hybrid position
• First 90 days in office for training
• Intermittent physical effort may include lifting to 25 lbs., walking, stopping, kneeling, crouching or crawling may be required
• Frequent sitting, use of a keyboard, reaching with hands and arms, talking, and hearing approximately 70% of the time; 30% or less time is spent standing
• Normal vision abilities required including close vision and ability to adjust focus
• Travel up to 10% of the time may be required