Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Customer Care Specialist

Job Description Summary

This position is responsible for providing assistance with the resolution of authorization and/or claim issues in various work queues resulting from and calls taken from facilities and providers. Acts as liaison between providers, internal departments and specific accounts, clients, and claims department.

Job Description

Resolves cases in queue due to member eligibility issues, referring provider verification or request, imaging provider verification, redirection, and retro reviews.Assists with authorization problem resolution through research and facilitating the resolution of the problem in a timely fashion.Process, forward, trend, and maintain records of authorization issues. Acts as a troubleshooter to resolve problems among internal departments.Handles special requests from Customers requiring manual workarounds or specials projects.Investigates written/verbal complaints involving authorizations, and resolves complex issues with Customers and Providers.Assists specific accounts who have special processes.Observes and tracks authorization problem trends and works with internal department for resolution.Assists with User Acceptance Testing (UAT).Provides phone back-up coverage for other teams as needed.

Responsibilities

Ability to review and interpret multiple contract/account information to successfully resolve issues regarding benefit plan administration; experience with account benefit structures.Demonstrated ability for problem solving, meeting deadlines, initiative and follow-through.Excellent written and verbal communication skills.Knowledge of pharmacy benefits management.Understanding of customer service performance metrics (ASA, abandonment rate, talk time).

Work Experience

Work Experience - Required:

Claims, Customer Service

Work Experience - Preferred:

Education

Education - Required:

GED, High School

Education - Preferred:

Bachelors

Certifications

Certifications - Required:

Certifications - Preferred:

Potential pay for this position ranges from $17.16 - $25.73 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law. 

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.