• Job Description

  Req#: R1030974

  
  Summary
  

  Responsible for providing a central contact for pharmacy related issues and private business. Accountable for quality control audits on pharmacy claims, membership files, customer inquiries, evaluation of potential claim or system problems, accuracy, and completion of reports.

  
  Description
  

  What You’ll Do:

  • Coordinates customer service and responds to pharmacy inquiries related to drug eligibility and drug benefits for the private business pharmacy plans.
  • Reviews, investigates, and resolves problems within the pharmacy benefit and processing of claims through the pharmacies.
  • Serves as liaison with the pharmacy benefit manager (PBM) and their account representatives.
  • Serves as central point of contact between the PBM, operations, and account representatives.
  • Coordinates and tests benefit changes or new benefit/drugs design scope codes.
  • Coordinates plan design testing, system testing, and system updates on the pharmacy benefit management system.
  • Processes and maintains daily, monthly, and quarterly reports containing analysis of pharmacy activity, eligibility, and processing of the pharmacy plan.
  • Performs quality control audits on all aspects of pharmacy benefit files, payment structure, and policy exclusions.
  • Creates/writes/edits/updates and manages content on the division’s internal and/or external websites.
  • Work environment: Typical office environment.
  • Work hours 9:00am - 5:30pm (Will need to be able to cover night shift when necessary 11:30am – 8pm)
  • Remote Position after in the office training.

  To Qualify for This Position, You’ll Need:

  • High School Diploma or equivalent
  • Two (2) years of job-related customer service and/or benefit claims experience.
  • Good judgment skills.
  • Effective customer service and organizational skills.
  • Demonstrated verbal and written communication skills.
  • Demonstrated proficiency in spelling, punctuation, and grammar.
  • Ability to handle confidential or sensitive information with discretion.
  • Microsoft Office.

  We Prefer That You Have:

  • Current state – Certified Pharmacy Technician License in good standings.

  What Blue Can Do For You:

  Our comprehensive benefits package includes:

  • 401(k) retirement savings plan with company match
  • Subsidized health plans and free vision coverage
  • Life insurance
  • Paid annual leave — the longer you work here, the more you earn
  • Nine paid holidays
  • On-site cafeterias and fitness centers in major locations
  • Wellness programs and a healthy lifestyle premium discount
  • Tuition assistance
  • Service recognition

  What to Expect Next:

  After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

  
  
  

  We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

  Equal Employment Opportunity Statement

  BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

  We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

  If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

• About the company

  When you hear "BlueCross BlueShield of South Carolina," you'll see people nodding in recognition. Most everyone knows who we are. As the only South Carolina-owned and operated health insurance carrier, we have been offering security to Palmetto State citizens for more than 70 years. We are also one of South Carolina's largest employers.

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