Pharmacy Operations Representative
Core
Support pharmacists in resolving medication inquiries and pharmacy-related issues for members and providers through inbound calls, outreach, and account-based collaboration.
Role type
Pharmacy Operations Representative (Customer Service & Operations)
Builds
Operational resolutions for pharmacy claims, coverage, and medication management issues
Domain
Health Insurance / Managed Care / Pharmacy Operations
Deliverable
client delivery
Required skills
Drug information skills, Managed care customer service experience, MS Office proficiency (Word, Excel, Access), Data analysis skills, Organizational skills
Preferred skills
Retail/Hospital/Specialty Pharmacy experience, PBM experience, Prior-authorization process knowledge, Utilization Management (UM) system familiarity, Clinical services support experience
Responsibilities
Manage inbound calls regarding medication and pharmacy issues, Conduct member and provider outreach, Collaborate with pharmacists on account-based work, Evaluate and resolve pharmacy-related issues with internal/external vendors, Facilitate clinical and benefit overrides in PBM claims systems, Support population health initiatives
Seniority
Individual Contributor