ALLEGIANCE BENEFIT PLAN MANAGEMENT Pharmacy CSR in MISSOULA, Montana
REPORTS TO: Pharmacy Service Team Manager LOCATION: Missoula FLSA STATUS: Non-ExemptPOSITION RESPONSIBILITIES:The Pharmacy Service Team 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.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 informationUpdates participant data to include new adds and COBRA enrollees as needed daily.Programs accepted plan overrides.Audits group benefit design set up at PBM.Drafts plan parameters to be approved by the plan sponsor detailing coverage, co-pay structure, reimbursement levels, administration charges, and coordination of benefits.Forwards signed client agreements to Legal Department and PBMs.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.Builds groups into the eligibility extract file in claims processing system; works with PBM to test file.Coordinates special programming needs with Plan Builders.Assists Claims Examiners by researching information on specific drugs as requested.Orders new group packets from PBMs to be distributed to members prior to coverage effective date; forwards packets to plan sponsor for distribution.Collaborates with Indexing Department to determine best practices for indexing PBM invoices and individual Rx claims.Contributes to the daily workflow with regular and punctual attendance.