Pbm Data Analyst Jobs in Arizona (NOW HIRING)

Description

The Pharmacy Customer Service Advocate assists member, providers, and pharmacies with inquiries for member's eligibility, claim status, precertification requirements, and claims coverage questions by phone, fax, email, and US mail, working independently within the scope of their duties. The Customer Service Advocate coordinates the handling of numerous daily, time-sensitive functions required to maintain an efficient workflow and direct all maters to a proper resolution. 

Job Responsibilities: 

Maintain HIPAA/PHI guidelines to ensure the confidentiality of all calls and documents

Interpret plan documents/plan guidelines

Determine eligibility by reviewing, researching, and analyzing information in the appropriate system

Use critical thinking and reasoning to manage workload with above average level

Maintain and enter information into systems as information is received

Forward all records to the appropriate parties

Record and respond to calls/emails/faxes from Member, Providers, and Pharmacies

Maintain high level of knowledge to answer specific Pharmacy Plan Benefit information or sharing guideline related questions

Review issues as they arise

Serve as a role model in demonstrating core values of customer service

Provide timely and thorough responses to internal and external customers

Escalate difficult issues to the appropriate party

Provide exceptional customer service for incoming/outgoing calls

Propose process improvements to enhance customer service satisfaction

Ensure compliance with service standards

Develop and execute plans to meet established goals

Provide continuous feedback to strengthen and optimize quality performance

Work cross-departmentally to improve or streamline procedures

Maintain up to date knowledge on industry trends and look for new data sources

Develop or improve current internal processes to improve overall quality

Accurate and complete documentation of all daily interactions

Special projects as assigned

Skills and Abilities: 

Excellent verbal and written communication skills with high attention to detail

Excellent customer service skills

Strong analytical and problem-solving skills

Confident decision-making abilities

Advanced Medical Pricing Solutions (AMPS) provides market leading healthcare cost containment services for self-funded employers, public entities, brokers, TPAs, payers and many other entities. As we continue to grow, we look for driven professionals who share our core values. 

We take a "one team" approach to keeping clients satisfied and engaged with our products and services for the long-term. 

Demonstrated ability to work independently, prioritize workloads, multi-task effectively, and manage priorities to meet deadlines 

Requirements

Education and Experience: 

High school diploma or equivalent required 

PBM Experience

Minimum 2 years customer service or claims experience in the Health Insurance Industry 

Preferred experience in Call Center Customer Service 

Preferred experience in Pharmacy Tech

Must have experience in handling multi-line telecommunication systems and electronic documentation software

Knowledge of medical/pharmaceutical terminology required 

Health Insurance/Eligibility and Benefit knowledge required 

Prior authorization experience preferred 

Bilingual a plus 

Physical Requirements: 

Indoor office environment with moderate noise 

Hybrid position 

First 90 days in office for training

Intermittent physical effort may include lifting to 25 lbs., walking, stopping, kneeling, crouching or crawling may be required 

Frequent sitting, use of a keyboard, reaching with hands and arms, talking, and hearing approximately 70% of the time; 30% or less time is spent standing 

Normal vision abilities required including close vision and ability to adjust focus 

 Travel up to 10% of the time may be required