Pharmacy Benefit Specialist – Remote Jobs Utah

Job Type: Pharmacy Benefit Specialist from home
Location: Utah work from home
Company: Aston Carter

The Pharmacy Benefit Specialist II is responsible for the efficient and accurate adjudication of pharmacy claims while providing excellent customer service to members, employer groups, providers, and other teams. This role involves rotating between pharmacy claims and customer service responsibilities and serving as a subject matter expert in both areas. Additionally, the Pharmacy Benefit Specialist II may act as a mentor to other staff members as directed by department leadership.

Responsibilities:

• Process and communicate various pharmacy benefits, including coordination of benefits, member reimbursements, coinsurance benefits, and mail-order prescriptions.
• Handle incoming calls from members, providers, facilities, employer groups, and other departments, providing superior customer service in line with company policies and quality standards.
• Educate callers on the proper use of their plans, coverage benefits, utilization, and administrative guidelines.
• Demonstrate excellent customer service skills, including problem-solving, telephone etiquette, and responsiveness.
• Ensure compliance with department phone standards and expectations related to call statistics, production, documentation, and quality/accuracy.
• Efficiently address and resolve problems during phone calls.
• Act as a resource for Pharmacy Benefit Specialist I employees, offering guidance on policy inquiries and questions.
• Meet or exceed department standards for call time and answered call percentage.
• Efficiently enter overrides for pharmacy claims while maintaining accuracy standards.
• Assist in the payment of claims for both members and pharmacies when assigned.
• Complete and analyze specialized reports to ensure timely and accurate claims adjudication.
• Collaborate with operational and pharmacy teams to educate staff and resolve issues.
• Maintain member confidentiality in accordance with internal policies and document customer history accurately.
• May assist with help desk calls as needed.

Requirements:

• Pharmacy Benefit Specialist I certification or Pharmacy Technician Certified (expired certifications are acceptable).
• Demonstrated experience in a pharmacy benefits support role.
• Ability to meet performance standards for a Pharmacy Benefit Specialist II.
• Strong customer service skills.
• Effective communication and problem-solving abilities.
• Proficiency in computer systems, typing, and relevant technologies.
• Experience mentoring or training on pharmacy or government benefits is a plus.