Benefit Specialist

Description:

• Processes and/or communicates multiple types of pharmacy benefits including coordination of benefits, direct member reimbursements, coinsurance benefits, and mail order prescriptions

• Receives incoming calls from members, providers, facilities, employer groups, and other departments

• Provides superior customer service that is consistent with policies, company values, and quality standards

• Educates callers on correct use of their plans, including coverage of benefits, utilization, and administrative guidelines, in collaboration with teammates and other departments. Makes exception / empowerment decisions within the established exception policy

• Consistently demonstrates excellent customer service skills including problem solving, telephone etiquette, and responsiveness to customers

• Ensures that all department phone standards and expectations are met pertaining to call statistics, production, documentation, and quality/accuracy

• Efficiently and quickly addresses and solves problems on phone calls

• Acts as a resource to all employees for policy inquiries, questions, and problems that arise. Acts as a mentor and willingly coaches and develops others under the direction of the team supervisor and trainer, and provides effective feedback to others as needed

• Meets or exceeds department standard for call time and answered call percentage in relation to the team average

• Efficiently and accurately enter overrides for pharmacy claims

• Meets or exceeds department standards for override audits

• When assigned, assists in the payment of claims for both members and pharmacies while maintaining accuracy standards

• Completes and analyzes specialized reports that are used to ensure timely and accurate claims adjudication

• Works closely with the operation and pharmacy teams to educate the staff and resolve problems

• Maintains the confidentiality of member's personal information to be compliant with internal confidentiality policy. Maintains customer history in member tracking using correct codes and detailed comments

• May help on help desk calls as department needs dictate

Qualifications:

• Pharmacy Benefit Specialist I certification or Pharmacy Technician Certified (does not have to be current – can be expired)

• Experience in a pharmacy benefits support role.

• Ability to provide superior customer service

• Ability to listen and communicate effectively

• Ability to problem solve and work under pressure

• Proficiency in navigating computer systems, typing, and technologies

• Experience mentoring or training on pharmacy or government benefits

Experience Level:

Entry Level