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Pharmacy Benefit Specialist II

Company: Aston Carter
Location: Colorado Springs
Posted on: November 23, 2022

Job Description:


Job Description: Responsible for expeditious and accurate adjudication of pharmacy claims, and the provision of excellent customer service to all members, employer groups, providers and other departments or teams. Rotates between pharmacy claims and customer service responsibilities and acts as a subject matter expert in both of these areas. Acts as a mentor to other staff as directed by department leadership. Job Essentials: --- Processes and/or communicates multiple types of pharmacy benefits including coordination of benefits, direct member reimbursements, coinsurance benefits, and mail order prescriptions. --- Receives incoming calls from providers, facilities, employer groups, and other departments. Provides superior customer service that is consistent with policies, company values, and quality standards. --- Educates callers on correct use of their plans, including coverage of benefits, utilization, and administrative guidelines, in collaboration with teammates and other departments. Makes exception / empowerment decisions within the established exception policy. --- Consistently demonstrates excellent customer service skills including problem solving, telephone etiquette, and responsiveness to customers. --- Ensures that all department phone standards and expectations are met pertaining to call statistics, production, documentation, and quality/accuracy. --- Efficiently and quickly addresses and solves problems on phone calls. --- Acts as a resource to all Pharmacy Benefit Specialist I employees for policy inquiries, questions, and problems that arise. Acts as a mentor and willingly coaches and develops others under the direction of the team supervisor and trainer, and provides effective feedback to other Pharmacy Benefits Specialists as needed. --- Meets or exceeds department standard for call time and answered call percentage in relation to the team average. --- Efficiently and accurately enter overrides for pharmacy claims. Meets or exceeds department standards for override audits. --- When assigned, assists in the payment of claims for both members and pharmacies while maintaining accuracy standards. --- Completes and analyzes specialized reports that are used to ensure timely and accurate claims adjudication. --- Works closely with the operation and pharmacy teams to educate the staff and resolve problems. --- Maintains the confidentiality of member's personal information to be compliant with internal confidentiality policy. Maintains customer history in member tracking using correct codes and detailed comments. --- May help on help desk calls as department needs dictate.


Pharmacy Benefit Specialist I Certification, Pharmacy Technician Certification, cbps, Customer service, call center, insurance verification, conflict resolution skills, de-escalation skills

Top Skills Details:

Pharmacy Benefit Specialist I Certification,Pharmacy Technician Certification,cbps

Additional Skills & Qualifications:

Minimum Qualifications: --- Pharmacy Benefit Specialist I certification or Pharmacy Technician Certified (does not have to be current - can be expired) --- Demonstrated experience in a pharmacy benefits support role. --- Demonstrated ability to meet performance standards for a Pharmacy Benefit Specialist II --- Demonstrated ability to provide superior customer service --- Demonstrated ability to listen and communicate effectively --- Demonstrated ability to problem solve and work under pressure --- Demonstrated proficiency in navigating computer systems, typing, and technologies --- Demonstrated experience mentoring or training on pharmacy or government benefits

Experience Level:

Intermediate Level

About Aston Carter:

Please Note: Scammers are posing as Aston Carter. We'll never contact you via Gmail, Telegram, or WhatsApp and we'll never solicit money from you.

At Aston Carter, we're dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions - from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.

Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients' capabilities by seeking solvers and delivering solutions to address today's workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit Aston Carter is a company within Allegis Group, a global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email ( for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.

Keywords: Aston Carter, Colorado Springs , Pharmacy Benefit Specialist II, Healthcare , Colorado Springs, Colorado

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