Pharmacy Customer Service Representative

Summary

Join Rightway as a Pharmacy Customer Service Representative and contribute to their mission of transforming healthcare outcomes. You'll be part of the RightwayRx Operations team, working directly with members and providers to resolve inquiries related to pharmacy benefits, claim adjudication, and utilization management. This role involves handling calls and correspondence, effectively communicating with members and providers, documenting interactions, assisting network pharmacies with prescription claims, and advocating for customers in problem resolution. You'll be a key player in creating a positive and collaborative work environment.

Requirements

• Bachelor’s Degree or equivalent relevant work experience
• Active/Current National Pharmacy Technician Certification
• 3-5 years of relevant work experience in a health plan, TPA or PBM contact center

Responsibilities

• Handles calls and correspondence (electronic and written) regarding pharmacy benefit inquiries from providers (pharmacy/physician) and members
• Effectively communicate issues and resolution to members and providers
• Document calls within a call tracking system using established protocols to ensure resolutions are clear, concise, and accurate
• Assist network pharmacies in processing prescription claims. Review claims for accuracy against benefit guidelines and contract standards
• Serve as a customer advocate in problem resolution and follow through
• Creates and supports and environment which fosters teamwork, cooperation, respect and diversity
• Perform other duties and projects as assigned

Preferred Qualifications

• Detail-oriented, analytical, intellectually curious, good listener, empathetic, ability to challenge status quo, values exemplar
• Prior experience working with health plan, TPA, or PBM contact center, effective & creative problem-solver, ability to prioritize and manage through change. Solid communication skills