Pharmacy Technician

Pharmacy Customer Service AdvocateThe Pharmacy Customer Service Advocate assists members, providers, and pharmacies with inquiries for member's eligibility, claim status, precertification requirements, and claims coverage questions by phone, fax, email, and US mail, working independently within the scope of their duties. The Customer Service Advocate coordinates the handling of numerous daily, time-sensitive functions required to maintain an efficient workflow and direct all matters to a proper resolution.Job Responsibilities:Maintain HIPAA/PHI guidelines to ensure the confidentiality of all calls and documentsInterpret plan documents/plan guidelinesDetermine eligibility by reviewing, researching, and analyzing information in the appropriate systemUse critical thinking and reasoning to manage workload with above average levelMaintain and enter information into systems as information is receivedForward all records to the appropriate partiesRecord and respond to calls/emails/faxes from Member, Providers, and PharmaciesMaintain high level of knowledge to answer specific Pharmacy Plan Benefit information or sharing guideline related questionsReview issues as they ariseServe as a role model in demonstrating core values of customer serviceProvide timely and thorough responses to internal and external customersEscalate difficult issues to the appropriate partyProvide exceptional customer service for incoming/outgoing callsPropose process improvements to enhance customer service satisfactionEnsure compliance with service standardsDevelop and execute plans to meet established goalsProvide continuous feedback to strengthen and optimize quality performanceWork cross-departmentally to improve or streamline proceduresMaintain up to date knowledge on industry trends and look for new data sourcesDevelop or improve current internal processes to improve overall qualityAccurate and complete documentation of all daily interactionsSpecial projects as assignedSkills and Abilities:Excellent verbal and written communication skills with high attention to detailExcellent customer service skillsStrong analytical and problem-solving skillsConfident decision-making abilitiesDemonstrated ability to work independently, prioritize workloads, multi-task effectively, and manage priorities to meet deadlinesEducation and Experience:High school diploma or equivalent requiredPBM ExperienceMinimum 2 years customer service or claims experience in the Health Insurance IndustryPreferred experience in Call Center Customer ServicePreferred experience in Pharmacy TechMust have experience in handling multi-line telecommunication systems and electronic documentation softwareKnowledge of medical/pharmaceutical terminology requiredHealth Insurance/Eligibility and Benefit knowledge requiredPrior authorization experience preferredBilingual a plusPhysical Requirements:Indoor office environment with moderate noiseHybrid positionFirst 90 days in office for trainingIntermittent physical effort may include lifting to 25 lbs., walking, stopping, kneeling, crouching or crawling may be requiredFrequent sitting, use of a keyboard, reaching with hands and arms, talking, and hearing approximately 70% of the time; 30% or less time is spent standingNormal vision abilities required including close vision and ability to adjust focusTravel up to 10% of the time may be required