Pharmacy Technician- Member Services
Pharmacy Technician- Member Services
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Job Description
Curative wants to change the view on what a health plan can be. Born out of the pandemic we created a health plan reinvented for a postpandemic world that is built around wholeperson affordable preventive care featuring more benefits. Curative is looking for a Pharmacy Technician who is passionate about helping the company as we work to reinvent healthcare options. Candidates will be able to utilize their previous experience in Pharmacy Operations/Customer Care by increasing satisfaction and retention by providing Curative health plan Members patients and providers with accurate consistent timely and meaningful information. They will provide support to Members while building rapport and collaborative relationships with current and prospective Members in accordance with compliance guidelines. This is a remote position with multiple shift options in a 24/7 call center.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Monitoring for prescription claims rejections from 3rd party pharmacies
Outreach to members and providers with information regarding rejection and offering alternative options as applicable
Working with the Curative pharmacy prior authorization team discussing PA decisions with members and providers as needed
Evaluating extenuating requests and processing overrides as appropriate in the CAPRx JUDI system
Working with the Pharmacy team on non formulary drug alternatives for member and provider notification
Contact 3rd party pharmacies to reprocess claims notify of drug alternatives prior authorization status.
Correct claims and prior authorization request as needed
SME on pharmacy and drug benefits handling escalated contacts from members providers pharmacies and member service team
Escalation support for after hours issues resolution as needed
Processing notifications to members services team for member outreach and status updates on prescription status
Working with leadership team on policy and process improvements
This position assumes and performs other duties project management and data reporting as assigned
Work adhering to US regulatory and Quality System requirements 21 CFR 820 etc).
QUALIFICATIONS
To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
Excellent attendance is critical to success in this position
Internal candidates must have been in their current role for at least 6 months and have no performance or attendance actions in effect.
Excellent computer and phone skills attention to detail process and policy adherence
Excellent verbal and written communication skills.
Strong interpersonal skills.
Active listening skills to accurately respond to inquiries and requests.
Exceptional organizational skills retention of policy and process a must
Intermediate skills minimum in google and microsoft office suite of products a must
Experience with Dialpad (or other VOIP phone systems) preferred but not required
Experience with Helpscout (or other email ticket systems) preferred but not required
Experience with JUDI (or other prescription claims systems) preferred but not required
Experience with slack gmail zoom conference preferred but not required
EDUCATION and/or EXPERIENCE
Minimum 5 years experience in pharmacy or PBM operations
Associates degree (A. A. or equivalent from twoyear college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.
CERTIFICATES LICENSES REGISTRATIONS
Active PTCB certification required
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Remote position
Must have a quiet place secure with no distractions to perform duties for work from home
Must have password protected stable internet access stipend will be provided
Work location MUST be secure and private to maintain HIPAA compliance for work from home
Office equipment will be supplied including: PC monitor keyboard mouse headset
While performing the duties of this Job the employee is regularly required to sit; use hands to type talk; and hear.
The employee is frequently required to reach with hands and arms.
Specific vision abilities required by this job include close vision distance vision color vision peripheral vision depth perception and ability to adjust focus.
We also request with the exception of emergencies that you do not request any time off within the first 120 days of employment. Any request within the first 120 days if approved will be unpaid
For this position the percentage of expected Travel is:0 of the time
TRAINING EXPECTATIONS
- You will attend a 23 week minimum remote training program.
- Attendance is mandatory for the full training program
- You will be required to take daily competency exams and a retention exam on the Friday of both weeks of
training. Passing grades are 90 or above. - We also request with the exception of emergencies that you do not request any time off within the first 120 days of employment. Any request within the first 120 days if approved will be unpaid
Required Experience:
IC
Employment Type
Full-Time
