Do you want a career where you can make a difference? Allegiance is a growing company with hometown values that is looking for dynamic candidates to join the team! A positive, team-oriented environment is provided with opportunities for advancement.
Allegiance offers full-time positions with evenings, weekends, and holidays off and a multi-faceted benefits package.
We pride ourselves in having a reputation for top-notch customer service. Make a difference. Start your career with Allegiance today!!
REPORTS TO: Pharmacy CSR Supervisor LOCATION: Missoula FLSA STATUS: Non-Exempt
The Pharmacy CSR is responsible for the customer service for all groups utilizing a Pharmacy Benefit Manager (PBM). This includes all support functions necessary to provide accurate information and courteous and timely service to all clients and plan participants. Occasional travel is required.
The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.
1. Answers telephone calls from PMBs, plan sponsors, plan participants, providers, and internal departments pertaining to pharmacy benefits, claims inquiries and programming; provides prompt, clear and accurate responses to requests for information2. Updates participant data to include new adds and COBRA enrollees as needed daily.3. Programs accepted plan overrides.4. Audits group benefit design set up at PBM.5. Drafts plan parameters to be approved by the plan sponsor detailing coverage, co-pay structure, reimbursement levels, administration charges, and coordination of benefits. 6. Forwards signed client agreements to Legal Department and PBMs.7. Collaborates with the Legal Department to ensure Rx coverage agrees with plan document language and with the Enrollment Department to ensure accurate information is printed on ID cards.8. Builds groups into the eligibility extract file in claims processing system; works with PBM to test file.9. Coordinates special programming needs with Plan Builders.10. Assists Claims Examiners by researching information on specific drugs as requested.11. Orders new group packets from PBMs to be distributed to members prior to coverage effective date; forwards packets to plan sponsor for distribution.12. Collaborates with Indexing Department to determine best practices for indexing PBM invoices and individual Rx claims.13. Contributes to the daily workflow with regular and punctual attendance.
NON-ESSENTIAL JOB FUNCTIONS:
- Meets personally with clients as necessary to assist them with questions pertaining to their pharmacy benefits.
- Assists Marketing Department with PBM questions as needed.
- Performs related or other assigned duties as required or directed.
- Requests individual paid claims reports from PBMs for submission to stop loss carrier; runs check report from claims processing system to verify payment for stop loss carrier.
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting 80% Reaching Some
Standing 10% Manual Dexterity High
Walking 10% Telephone Yes
Kneeling Some Computer Screen High (visual acuity corrected to 20/30)
Bending Some Lifting up to 30 pounds
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Education: High school graduation or GED required. College degree and/or training in medical terminology preferred.
Certification(s) Required: None
Minimum Experience: Previous experience with computer software applications is required. Work experience with group health benefits or in the health insurance industry preferred.
Other Qualifications: Excellent oral and written communication skills required.
PC skills, including Windows, Excel, Access, Word, internet navigation, and email applications. PowerPoint preferred. Ability to learn all functions of the claims processing software as is necessary for data entry, research and report generation. Must be able to adapt to software changes as they occur.
Accurate data entry and typing skills.
Knowledge of medical terminology and basic health insurance concepts.
Excellent listening skills.
Basic mathematical skills.
Ability to gain thorough knowledge of pharmacy benefit systems and contracting.
High level of interpersonal skills to work effectively with others.
Ability to organize and recall large amounts of detailed information.
Ability to project a professional image and positive attitude in any work environment.
Ability to comply with privacy and confidentiality standards.
Ability to be flexible, work under pressure and meet deadlines.
Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
Ability to take initiative and work independently.
Ability to operate typical office equipment.
Working knowledge of general office procedures.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.
*Allegiance Benefit Plan Management, INC is an Equal Opportunity Employer.Job Posted by ApplicantPro