PHARMACY BENEFITS SPECIALIST (CUSTOMER SERVICE)

Pharmacy Benefits Specialist (Customer Service) page is loaded Pharmacy Benefits Specialist (Customer Service)

Pharmacy Benefits Specialist (Customer Service)

locationsSelectHealth - Murray time typeFull time posted onPosted 5 Days Ago job requisition idR35198 Job Description :

Responsible for expeditious and accurate adjudication of pharmacy claims, and the provision of excellent customer service to all members, employer groups, providers and other departments or teams.

To rotate between pharmacy claims and customer service responsibilities.Job Essentials

Processes and / or communicates multiple types of pharmacy benefits including coordination of benefits, direct member reimbursements, coinsurance benefits and mail order prescriptions.

Receives incoming calls from members, providers, facilities, employer groups, and other departments. Provides superior customer service that is consistent with policies, company values and quality standards.

Educates callers on correct use of their plans, including coverage of benefits, utilization, and administrative guidelines, in collaboration with teammates and other departments.

Makes exception / empowerment decisions within the established exception policy.

Consistently demonstrates excellent customer service skills including problem solving, telephone etiquette, and responsiveness to customers.

Ensures that all department standards and expectations are met pertaining to call statistics, production, documentation, and quality / accuracy.

Efficiently and quickly addresses and solves problems on phone calls.

Meet s or exceeds department standards for call time and answered call percentage in relation to the team average.

Efficiently and accurately enters overrides for pharmacy claims. Meets or exceeds department standards for override audits.

Meets or exceeds aux code standards for the department.

When assigned, assists in the payment of claims for both members and pharmacies while maintaining accuracy standards.

Completes and analyzes specialized reports that are used to ensure timely and accurate claims adjudication.

Works closely with the operation and pharmacy teams to educate the staff and resolve problems.

Maintains the confidentiality of member's personal information to be compliant with internal confidentiality policy.

Maintains customer history in member tracking using correct codes and detailed comments.

Minimum Qualifications

One year combined experience in any of the following : medical / pharmacy claims processing; health benefit coordination;

customer service experience; pharmacy tecnician experience.

and -

Experience utilizing word processing software.

Preferred Qualifications

Current national Pharmacy Technician certification.

Problem solving capabilities, analytical skills, self-motivated, and able to work well under pressure and through frequent interruptions.

and -

Demonstrated excellent verbal and written communication skills individually and within groups.

and -

Experience with Facets / AWD system.

and -

Health care customer service and claims processing experience.

Physical Requirements :

Manual dexterity, hearing, seeing, speaking.

Location :

SelectHealth - Murray Work City :

Murray Work State :

Utah Scheduled Weekly Hours :

40 Intermountain Healthcare is a team of more than 41,000 caregivers who serve the healthcare needs of people across the Intermountain West, primarily in Utah, Idaho, and Nevada.

We are an integrated, not-for-profit health system based in Salt Lake City, Utah, with clinics, a medical group, affiliate networks, hospitals, homecare, telehealth, health insurance plans, and other services, along with wholly owned subsidiaries including SelectHealth, Saltzer Health, and Intermountain Healthcare in Nevada.

Our mission is : Helping people live the healthiest lives possible.

Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.

Get In Touch

Introduce yourself to our Talent Acquisition team and we will get in touch if there is a role that seems like a good match.

PEAK) Path to Education, Advancement, and Knowledge

Intermountain Healthcares PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution.

The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates.

Caregivers are eligible to participate in PEAK on day 1 of employment.

We intentionally work toward an Intermountain Healthcare that reflects our diverse communities and provides culturally competent care, health equity, and a sense of belonging amongst all our caregivers (employees).

This is an important part of fulfilling our mission to help people live the healthiest lives possible. The three pillars of our work are talent experience with Intermountain (application, internship, development, etc.

community benefit, and care delivery.

Learn more about diversity at Intermountain,

The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and / or labor market analysis have been included.

Other duties may be assigned by the supervisor.

All positions subject to close without notice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability or protected veteran status.

Women, minorities, individuals with disabilities, and veterans are encouraged to apply.

Thanks for your interest in continuing your career with our team!