Customer Service - Pharmacy Technical Support Specialist 105-1078

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.
• Responsible for processing prior authorizations for medications.
• Work may require overtime to meet deadlines. Work may also 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.