Description:The Customer Care Specialist handles incoming calls regarding questions about a members prescription benefit. These calls include but are not limited to what a members copay would be, if a medication is covered, faxing forms to doctors for authorization on a medication before it can be prescribed, etc.
Understand, apply, and communicate client-specific prescription benefit and pharmacy claim processing information to include things like: formularies (list of covered medications), clinical programs to improve health and reduce costs, member out of pocket costs, appeal rights prior authorization/exception processes and much more
Educate members on how to best utilize their benefits
Troubleshoot pharmacy claims real-time to include verifying information the pharmacy submits, comparing the claim result to benefit rules, and entering allowed overrides to allow claims to pay
Skills:Computer Skills, Customer Service, insurance verification, Inbound Call, Medical Claim, prior authorization, member service, prescription benefitsAdditional Skills & Qualifications:
2+ years of Prior Medical healthcare within pharmacy, benefits, insurance , specialty pharmacy, pharmacy technician or healthcare customer service experience
Excellent phone etiquette and typing skills (40wpm, 500kph)
Basic knowledge of Microsoft Office and internet required. Will be reviewing documents of pharmacy benefits.
Excellent oral and written communication skills
Willing to work between M-F 8A- 9P CST and occasional Saturdays! About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
