Pharmacy Customer Service Representative

ProCare Rx; Gainesville (GA); On-site; USD 35,000 - 50,000; Full time

Job summary

A leading healthcare company seeks a Pharmacy Customer Service Representative in Gainesville, GA. This role involves providing customer support for pharmacy benefits, handling inquiries via phone, fax, and email, and ensuring accurate claim processing. The ideal candidate will have strong communication and organizational skills, with a minimum of two years' customer service experience and a high school diploma. Join ProCare Rx and contribute to enriching customer experiences in pharmacy services.

Qualifications

• Minimum two years experience in a customer service position, preferably in a call center environment.
• Strong customer service orientation and excellent communication skills.
• Proficient in Windows-based applications.

Responsibilities

• Answers incoming telephone calls related to pharmacy provider support or member benefit coverage determinations.
• Enrolls new members and processes terminations as needed.
• Maintains pharmacy call log summary and performs transaction overrides.

Skills

Customer Service Orientation

Communication Skills

Attention to Detail

Flexibility

Education

High school diploma or equivalent

Post high school education preferred

Specialized training as a Certified Pharmacy Technician

Job description

Pharmacy Customer Service Representative

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Pharmacy Customer Service Representative

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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.

Job Details

Description

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 [phone] or email us at [e-mail].

ProCare Rx is an Equal Opportunity Employer.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care

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