Pharmacy Benefit Representative

Job Description

SUMMARY: Pharmacy Benefit Representative performs a variety of functions related to workers’ compensation claims and personal injury protection claims; i.e. the prescription, DMEPOS and ancillary benefits. Representative supports various claim processing services including handling client and member inquiries and problem resolutions, performing duties associated with claim adjudication and billing. Functions as a primary resource in providing customer support for injury claim clients and services.

PRINCIPLE RESPONSIBILITIES include but are not limited to:

Support multiple client program offerings

Handling general client inquiries, service calls, and problem resolution, meeting EHIM’s performance standards

Effectively communicate with multiple parties to complete tasks from beginning to end

Performs benefit authorizations and modification as required and approved by client

Maintain up to date documentation of communications and activities between EHIM and client and/or member through EHIM system and operations

Proactively keeps themselves and the department educated on industry trends and developments to accurately communicate to clients

Performs various related duties and special projects as assigned

Follows all policies and procedures related to job responsibilities

SKILLS AND REQUIREMENTS

High school diploma or equivalent required, post high school education preferred.

Minimum two years’ experience in a customer service position.

Work experience as a pharmacy technician, DMEPOS provider, claims adjuster, or a similar service position in health care or injury claim industry is preferred.

Must have excellent communication skills and the ability to work effectively with clients, pharmacies, vendors, and plan members.

Proficient PC skills in Windows-based applications.

Possess strong analytical skills and independent thinking/creativity.

Ability to be flexible and quickly adapt to changing needs within the department.

Must be highly organized with strong attention to detail.

Must be flexible with scheduled work hours.

Ability to work under general direction, on multiple tasks with demanding timelines.

Managed care background and knowledge of pharmacy terminology desired.

PHYSICAL DEMANDS

Requires sitting, standing, and occasional light lifting

ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at or email us at .

ProCare Rx is an Equal Opportunity Employer.

Full-time