Provider Relations Specialist

Insight Global; Eagan (MN); On-site; USD 52,000 - 76,000; Full time

Job summary

Insight Global is seeking an Associate Provider Relations Specialist for a large PBM client. You will conduct outreach to pharmacies in the client’s networks and ensure outbound communications are accurate and timely.

The role also manages extension requests for claims processing timeframes and triages inquiries in the Pharmacy Provider Relations inbox. The candidate should have a business-related degree, PBM or pharmacy operations exposure, and strong organizational, privacy, and collaboration

Qualifications

• Bachelor's degree in Business or related field or equivalent
• HS diploma from an accredited school or equivalent GED required
• 1 year of work experience in a call center, customer service, operations, retail pharmacy, pharmacy technician, or PBM
• Demonstrated ability to problem solve complex issues in a timely manner
• Strong customer service and collaboration skills
• Enhanced organizational skills with the ability to work on multiple tasks simultaneously
• Ability to work with confidential data and maintain privacy
• Ability to evaluate and interpret policies and procedures
• Ability to work in a fast-paced, collaborative team environment
• Proficient in Microsoft applications such as Outlook, Word and Excel
• Experience working with RxClaim or other claims processing systems
• Pharmacy Technician certification (CPhT) or equivalent pharmacy experience

Responsibilities

• Research and resolve claims and conduct pharmacy outreach to support regulatory, client commitments and other initiatives as assigned
• Research and escalate inquiries received through the Pharmacy Provider Relations email box
• Process claims reversals
• Identify and participate in implementing department level process improvements
• Prepare pharmacy outreach reporting to internal and external stakeholders
• Manage and resolve requests to update the transaction control table in order to extend the timely filing
• Other duties as assigned

Skills

Problem solving

Customer service

Collaboration

Organizational skills

Data privacy

Policy interpretation

Fast-paced team work

Microsoft Office

RxClaim systems

Education

Bachelor's degree in Business or related field

HS diploma / GED

CPhT certification

Tools

Outlook

Word

Excel

Job description

Job Description

Insight Global is seeking an Associate Provider Relations Specialist for a large PBM client of ours. This individual is responsible for conducting outreach to pharmacies participating in the client's pharmacy networks and ensuring the information provided during outbound communications is accurate and delivered in a timely manner. This position is responsible for managing extension requests for the claims processing time frame and triaging inquires received in the Pharmacy Provider Relations email box.

The main responsibilities of this role include the following:

• Research and resolve claims and conduct pharmacy outreach to support regulatory, client commitments and other initiatives as assigned
• Research and escalate inquiries received through the Pharmacy Provider Relations email box
• Process claims reversals
• Identify and participate in implementing department level process improvements
• Prepare pharmacy outreach reporting to internal and external stakeholders
• Manage and resolve requests to update the transaction control table in order to extend the timely filing
• Other duties as assigned

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [e-mail]. To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Skills and Requirements

• Bachelor's degree in Business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required
• 1 year of work experience in a call center, customer service, operations, retail pharmacy, pharmacy technician, or Pharmacy Benefit Management (PBM)
• Demonstrated ability to problem solve complex issues in a timely manner
• Strong customer service and collaboration skills
• Enhanced organizational skills with the ability to work on multiple tasks simultaneously
• Ability to work with confidential data and maintain privacy
• Ability to evaluate and interpret policies and procedures
• Ability to work in a fast-paced, collaborative team environment
• Proficient in Microsoft applications such as Outlook, Word and Excel
• Experience working with RxClaim or other claims processing systems
• Pharmacy Technician certification (CPhT) or equivalent pharmacy experience

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [e-mail].