Pharmacy Services Specialist 2 - Team Lead

About This Role

This role involves communicating with members, providers, and clients to explain pharmacy benefits, assist with prior authorizations, and resolve claims and eligibility issues. The specialist acts as a liaison between the Health Plan and stakeholders, identifies root causes, and supports team development as a subject matter expert and trainer.

Responsibilities

• Resolve claims processing issues for Health Plan products using pharmacy claims systems and departmental tools
• Provide guidance and education to members on their benefit plan to maximize coverage value
• Investigate and resolve complex issues, escalating cases as needed and coordinating with personnel including pharmacies and providers
• Review and update member eligibility information during inquiries, adhering to HIPAA requirements and pharmacy procedures
• Establish and maintain excellent working relationships with key internal and external operational personnel
• Provide coaching and training to Pharmacy Services Specialist 1 staff in collaboration with the Call Center Manager
• Collect, review, and report on quality control activities for Pharmacy Services Specialist 1 staff
• Provide oversight and reporting on performance measure goals set by the pharmacy department

Requirements

• Ability to lead a team and provide direction
• Good phone etiquette and effective verbal and written communication skills
• Ability to document clearly and concisely
• Strong customer service skills
• Excellent interpersonal, listening and communication skills
• Ability to use and navigate multiple computer applications to research and address caller needs
• Excellent analytical, problem-solving skills and attention to detail
• Ability to work independently and in a team environment
• Ability to work in a fast-paced environment while maintaining accuracy and performance standards
• Proficient in typing and basic computer skills, particularly Microsoft Word and Excel

Qualifications

• H.S. Diploma/GED Equivalent
• 3 Years of Experience

Nice to Have

• Certified Pharmacy Technician (CPhT)
• Knowledge of prescription terminology and pharmacy practices and procedures

Skills

* Required skills

Benefits