Pharmacy Customer Service Representative

Summary

Join Rightway as a Pharmacy Customer Service Representative and contribute to our mission of transforming healthcare outcomes. You will be part of the RightwayRx Operations team, working on a new PBM model focused on fairness, transparency, and consumer empowerment. This role involves handling member and provider inquiries regarding pharmacy benefits, claim adjudication, and utilization management. You will communicate effectively, document interactions, assist with claim processing, and advocate for customers. The ideal candidate possesses a Bachelor's degree or equivalent experience, a National Pharmacy Technician Certification, and 3-5 years of relevant experience in a health plan, TPA, or PBM contact center. You will be detail-oriented, analytical, and possess strong communication skills.

Requirements

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

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

Benefits

$21-22/HR