Member Care Advocate

What We're About... TrueScripts Management Services is a pharmacist-founded, fully transparent Prescription Benefit Manager that has been revolutionizing the PBM industry since 2014. Our mission is to build lasting relationships by providing prescription benefit expertise at a personal and customized level to ensure optimum value at the lowest possible cost. We are committed to lowering prescription drug spending, achieving clinically effective outcomes, and always delivering Amazing Care. Did we mention Amazing Care ? Good! Because this is so much more than just our tagline. It is the foundation upon which our business was built. We believe that Amazing Care starts from within, and our culture is reflective of this philosophy.

Our team members enjoy :

A wide range of health insurance options including medical, dental and vision

A strong salary and bonus program

A robust 401k and company match

Truescripts is transitioning to an ESOP, a team member owned company! Each year team members are allocated shares of stock through our ESOP, a Qualified Retirement plan!

A wellness program including financial incentives, chiropractic and massage services, and fitness stipends

A cohesive, family-based culture

Charitable contributions and volunteer time

Ok, enough about us. Here's what we need from you :

A future team members' values need to align with TrueScripts' core values of

Integrity, Respect, Innovation,

and

Service.

This match in value systems is critical for our team's chemistry and continued success. Our culture is positive, and our people possess a 'can do, proactive attitude. Honesty and transparency are the foundation that we build upon. What sets us apart from our competitors is the programs that we bring, the education that we provide, and the utmost respect for clients and their members to assist them when and where needed.

Position Overview :

The Member Care Advocate is responsible for performing all tasks relative to in-house and external communications with TrueScripts members, doctor's offices' and pharmacies. This position responds to member and client inquiries, assists members with appropriate prescription benefits, and problem solves any issues in our claims system. The role provides administrative support to Member Care Leadership, Client Success & Executive teams.

Primary Roles and Responsibilities :

Account Inquiries & Claims Processing

Assist TrueScripts' members with pharmacy claims processing and plan benefits

Receive phone calls / emails from members, clients, pharmacies and / or physician offices

Troubleshoot claim processing problems and / or inquiries in claims adjudication system

Respond to website inquiries

Become proficient in all aspects of claims adjudication system

Communicate escalated member service concerns to manager

Account Support

QA testing for client transitions / changes

Complete pharmacy contact sheet for fax notifications

Claims Logging, Invoicing & Reporting

Log Specialty Care, Brand Care, Paper Claims, and Fee for Prior Authorizations on SharePoint

Log Specialty and Non-Specialty Prior Authorization approvals on SharePoint

Prepare and send weekly / monthly invoices to the Accounting team

Document actions and outcomes in the client database

Requirements

Education :

High School Diploma, 2-year college degree in related field preferred

Experience / Knowledge :

Two years of applicable experience preferred

Pharmacy technician or equivalent experience preferred

Innovative thinking

Ability to explain plans to members and partnered pharmacies

Knowledge of claims processing helpful

Analytical thinking and attention to detail

Excellent communication and customer relations skills

Problem solving skills

Ability to multi-task and prioritize in an ever-changing environment

Strong computer skills including Microsoft Office (Excel, Word, PowerPoint, Outlook)