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    Pharmacy Customer Service Representative - Gainesville, United States - Burgess Information Systems, Inc.

    Burgess Information Systems, Inc.
    Burgess Information Systems, Inc. Gainesville, United States

    1 week ago

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    Description

    Job Description

    Job Description

    SUMMARY:

    Performs a variety of functions related to pharmacy benefit management support including but not limited to provider support and client and member prescription claim processing services. Functions as a first line resource in providing customer support for prescription benefit services primarily through phone, fax, and email.

    PRINCIPLE RESPONSIBILITIES includes but are not limited to:

    • Answers incoming telephone calls related to pharmacy provider support or member benefit coverage determinations using established protocols and plan rules.
    • Reviews daily claim rejections and reference codes to determine if follow-up with Pharmacy/Member is required and will follow up with pharmacy/member as needed for claim resolution.
    • Enrolls new members and/or processes terminations as needed.
    • Maintains pharmacy call log summary.
    • Performs transaction overrides as required and approved by client groups. Maintains complete documentation of formulary overrides in proper notes section of member profiles.
    • Develops automated reference materials (intranet access) of updated plan information.
    • Serves as Training Facilitator for new recruits in the pharmacy call center.
    • Voluntary participation in on-call rotation covering one weekday evening and a weekend shift on an alternate rotation basis.
    • Assists with the implementation, QA, plan review, and claims unit testing of new plans and any client group wide change as needed.
    • Performs various related duties as assigned including but not limited to Pharmacy Network updates; Pharmacy direct member reimbursements; ID card management and distribution; etc.

    SKILLS AND REQUIREMENTS:

    • Education:
      • High school diploma or equivalent required, post high school education preferred.
      • Specialized training as a Certified Pharmacy Technician preferred.
    • Experience:
      • Minimum two years experience in a customer service position, preferably in a call center environment.
      • Work experience as a pharmacy technician or a similar service position in the health care industry is a strong plus.
    • Must have strong customer service orientation and excellent communication skills, and the ability to work effectively with clients, pharmacies and plan members.
    • Proficient PC skills in Windows-based applications.
    • Health insurance background and knowledge of pharmacy terminology desired.
    • Ability to be flexible and quickly adapt to the changing needs in the department.
    • Must be highly organized with strong attention to detail.
    • Must be flexible with scheduled work hours.
    • Must be willing to provide pharmacy on-call support and coverage on a rotational basis.

    PHYSICAL DEMANDS

    Requires sitting, standing and occasional light lifting.

    ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at or email us at

    ProCare Rx is an Equal Opportunity Employer.

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