Pharmacy Benefit Specialist I, II

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 members personal information to be compliant with internal confidentiality policy.

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

Minimum Qualifications

Demonstrated experience in any of the following:

Medical/pharmacy claims processing

Health benefit coordination

Customer service

Pharmacy technician

Demonstrated ability to provide superior customer service

Demonstrated ability to listen and communicate effectively

Demonstrated ability to problem solve and work under pressure

Demonstrated proficiency in navigating computer systems, typing and technologies

Preferred Qualifications

Current National Pharmacy Technician certification

Call center experience

Bilingual in English and Spanish

Physical Requirements:

Manual dexterity, hearing, seeing, speaking.

Location:

SelectHealth – Idaho, SelectHealth – Las Vegas, SelectHealth – Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$19.73 – $30.06

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

All positions subject to close without notice.