Under the direct supervision of the Supervisor, Pharmacy Services Call Center, the Pharmacy Call Center Technician is responsible for providing knowledgeable and courteous customer assistance and response to members, providers and Pharmacy Call Center Technician inquiries.
Principal Accountabilities:
• Handles calls and correspondence regarding pharmacy issues from providers/physicians and members. Identifies and/or responds to inquiries, benefit payments, complaints, dissatisfactions, grievances and claim issues. Document calls in inquiry tracking system. Using established protocols ensures resolutions provided are presented in a clear and accurate manner. Facilitates problem resolution and acts as customers advocate.
• Reviews daily work activity report to self-monitor performance and productivity standards. Identifies deficiencies/problems and adjust behavior and work activities as appropriate. Follows internal process and procedures to ensure activities are handled in accordance with departmental and company policies/procedures.
• Assists with entering prior authorizations when required; provides follow up assistance for prior authorization requests, follow up with request from physicians for denial letters, provides assistance in gathering historical claim information as required. Provides Level II Pharmacy Technician, Supervisor and/or Pharmacist with background data needed for claim review, appeals and grievances.