What you’ll do

In a few words…

As the Rx Customer Service Team Leader, you will support management in the oversight of team scheduling, training, service level metrics and quality monitoring. Additionally, you will assist Rx Customer Specialists in all incoming and outgoing communications (calls, emails and fax) with pharmacies, beneficiaries and prescribers, as necessary. You will use RxPlatform and other resources, as necessary, to resolve the needs of the caller.

The fundamentals for the job…

  • Prepare monthly schedules taking in consideration call volumes, peak hours, personnel availability and seasonal events.
  • Monitor Rx Customer teams’ timeliness and attendance, ensuring specialists are complying with their scheduled hours and that the information included in ADP is correct.
  • Monitor center calls and back-office duties for quality, compliance and employee development purposes.
  • Coordinate both team and one-on-one training as needed.
  • Assist Rx Customer Service Specialists in managing all incoming calls, emails, faxes, and web-generated requests from pharmacies, beneficiaries and prescribers including: coverage determination, exception and appeal status and rejection support including overrides.
  • Real-time, daily and monthly monitoring of call center performance metrics to ensure proper adjustments are made in a timely manner and that all calls are managed within the service-level standards set by CMS and our Clients.
  • Document Administrative PA request inquiries, issues, status and resolution in accordance with federal and department / company policies and guidelines.
  • Answers questions and recommends corrective actions to address customer complaints, payment status, manual reversal requests, benefit/eligibility support, provider portal support and response to price appeals.
  • Member card production, provider directories and conduct client satisfaction surveys

What you’re made of

The bold requirements…

  • High School Diploma. Pharmacy Technician Associate’s Degree. Bachelor’s Degree a plus.
  • Current/Active Certified Pharmacy Technician License is a big plus.
  • Preferred: Minimum of: 1 year working in a Pharmacy Call Center, OR 2 years working in a retail or hospital pharmacy setting, OR 3 years working in a non-pharmacy related customer service role preferred;
  • Knowledge of PBM clinical operations and Medicare Part D preferred;
  • Computer proficiency, knowledge of Microsoft Office products, and Internet experience.
  • Must be able to communicate effectively (read, speak, and write) in English and Spanish.
  • Attention to detail; organizational skills; analytical and critical thinking; superior interpersonal and customer service skills.
  • Previous experience in insurance, pharmacy, and / or healthcare preferred;
  • Computer proficiency, knowledge of Microsoft Office products (mostly in Excel), and Internet experience (the digital basics).
  • Must be able to communicate effectively (read, write, speak, daydream, argue, flatter, retort wittily etc.) in English and Spanish.

That something extra we´d love to see…

  1. Analytical: You value the power of context & enjoy examining the past. You get the present by analyzing (sometimes over-analyzing) events leading up to it. This methodology is super helpful, but can provoke analysis-fatigue in those within earshot. Good thing you’re aware of this.
  2. Motivator: Make the max out of anything and focus on strengths as a way to stimulate personal and group excellence. They seek to transform something strong into something superb. These are the people that say things like “the impossible just takes a little bit longer”.
  3. Detailed: Nothing gets by you and you rarely forget a thing. When learning some new procedure, you’re the type to take notes. When everyone else is still lost, you’re already at the next steps. Others count on this skill of yours. Maybe due to your detailed nature, you are also exquisitely good at planning. You like to make plans and follow through, meticulously.
  4. Fixer / Problem solver: You like to provide comprehensive solutions, keeping in mind both internal and external needs. You keep with the mantra of always being part of the solution (not the precipitate). Those who precipitate, you’ve learned, repent at leisure
  5. Leader / Mentor: Sincerely and deeply concerned for the professional success of their team. You advise, counsel, guide, teach, preach and overreach. Your heart is true. It’s expected that others will disappoint you.

 

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is absolutely not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of gender, race/ethnicity, gender identity, sexual orientation, protected veteran status, disability, or other protected group status.

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