Pharmacy Customer Associate II

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.

BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offer consumers and providers an unparalleled level of service that's easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer's treatment journey.

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.

How you will make an impact:

• 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 to include but not limited to: 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; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
• 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 HS diploma or equivalent and a minimum of 1 year of the company's experience in an automated customer service environment; or any combination of education and experience which would provide an equivalent background.

Preferred skills, capabilities, and experiences:

• General knowledge of company pharmacy services, products, insurance benefits, contracts and claims preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $18.66 to $29.32 hourly

Locations: Illinois, Nevada

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion, consistent with the law.