Pharmacy Customer Associate II

Shift: Monday – Friday; 11:30am – 8:00pm EST Location: On-site, with an opportunity to transition to hybrid. Alternate locations may be considered if candidates reside within a commuting distance from an office. Onsite: This role requires associates to work from the posted locations full-time, enabling consistent face-to-face collaboration, teamwork, and direct engagement. This policy promotes an environment built on in-person interaction, communication, and immediate support. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Overview The Pharmacy Customer Associate II is responsible for responding to moderately complex customer questions via telephone and written correspondence regarding pharmacy retail and mail order prescriptions. A successful Benefits Investigation professional demonstrates a strong foundation in healthcare coverage analysis, claims processing, and clear communication. Responsibilities Develops and maintains positive customer relations and coordinates with functions within the company to ensure customer requests are handled and resolved appropriately and in a timely manner. Interacts with internal and external customers (could include subscribers, providers, group or benefit administrators, physician offices, third party representatives, and other Blue Cross Plans) to provide claims, customer service, and/or membership support. Responds to client issues via telephone and written correspondence regarding insurance benefits member, provider contracts, eligibility, claims, etc. Proficiency in adjudicating claims through Pharmacy Benefit Managers (PBMs), with the ability to accurately read, interpret, and troubleshoot both paid and rejected claims. Completes necessary research to provide proactive, thorough solutions. Ability to research and interpret both medical and pharmacy benefit plans, including a comprehensive understanding of benefit structures such as copays, coinsurance, deductibles, out-of-pocket maximums, and coordination of benefits. Displays ownership of service requests ensuring high quality resolution and follow-through. Supports and guides the customer with their personal options and decisions and helps the customer become knowledgeable and confident about using technology, tools and resources available to them. Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers. Working knowledge of pharmacy and medical terminology and the ability to interpret prescriptions, including selecting appropriate dosing and units based on day supply requirements. Strong attention to detail with the ability to analyze complex information, identify discrepancies, and ensure accurate benefit determination. Excellent written and verbal communication skills to clearly document assessments and effectively convey benefit information to internal and external stakeholders. Additional expectations include proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast‑paced, high‑pressure environment; strong verbal and written communication skills, both with virtual and in‑person interactions; attention to detail, critical thinking, and problem solving; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual effort. Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary. Performs other duties as assigned. Minimum Requirements Requires a high school diploma or equivalent and a minimum of 1 year of experience in an automated customer service environment; or any combination of education and experience that would provide an equivalent background. Preferred Skills, Capabilities, and Experiences General knowledge of pharmacy services, products, insurance benefits, contracts and claims preferred. Professional Competencies (for URAC accredited areas) Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills. Compensation Salary range for this specific position is $18.66 to $29.32 hourly. Benefits Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution, subject to eligibility requirements. EEO Statement Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. #J-18808-Ljbffr