Medicare Pharmacy CSR (Remote PST Hours)

About the position

Responsibilities

• Handle and record inbound pharmacy calls from members, providers, and pharmacies.
• Provide coordination and processing of pharmacy prior authorization requests and/or appeals.
• Explain Point of Sale claims adjudication and relevant policies to providers, members, and pharmacies.
• Assist with clerical services and other day-to-day operations as delegated.
• Effectively communicate plan benefit information, including formulary information and copay amounts.
• Assist members and providers with initiating oral and written coverage determinations and appeals.
• Record calls accurately in the call tracking system.
• Maintain specific quality and quantity standards.

Requirements

• Experience working in healthcare, preferably in pharmacy or health insurance.
• Excellent communication skills, both written and verbal.
• Customer service experience in a remote setting is a plus.
• Solid and steady work history.
• Ability to work Mountain Standard Time hours of 9am to 6pm, Monday through Friday.