Apply on Employer Site

Corewell Health · 3 weeks ago

Pharmacy Customer Service Representative

United States

Full-time

Remote

Entry Level

1+ years exp

Corewell Health is a healthcare organization seeking a Pharmacy Customer Service Representative. This role involves providing efficient and accurate responses to customers regarding health plan benefits, resolving complex problems, and educating customers on drug formulary guidelines.

Health CareHospitalMedical

H1B Sponsor Likely

Responsibilities

Demonstrates high competency in analyzing, evaluating, and responding to complex pharmacy benefit inquiries from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products within departmental guidelines. Professional and pleasant interactions are ongoing expectations

Utilizes clinical knowledge from pharmacy experience and/or education to be able to effectively discuss covered alternatives to find less expensive options on the formulary to treat diagnosis

Collaborating with internal and external resources, promptly provides customers with information and education concerning the drug formulary and prior authorization (coverage determination) requests and ensuring they are completed in a timely manner in accordance with NCQA & CMS requirements

Promptly recognizes customer concerns, grievances, and/or appeal rights resolving or escalating to the proper channels to achieve positive outcomes

Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements

Maintains CPhT certification through continuing education via CE Credits to ensure accuracy, consistency, and knowledge of current pharmacy practices/drug changes. *If currently certified/licensed

Effectively documents all service interactions with customers within appropriate systems according to guidelines

Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule

Qualification

Customer servicePharmacy technician experiencePharmacy billingCPhT certificationCommunication skills

Required

High School Diploma or equivalent

1 year of relevant experience customer-facing service on phone or face to face; customer service, high volume call center, insurance environment relevant to benefits, and/or managed health care

2 years of relevant experience Pharmacy technician experience, pharmacy billing/claim adjudication

Preferred

Associate's Degree

CRT-Pharmacy Technician, Certified (CPHT) - PTCB Pharmacy Technician Certification Board Upon Hire

LIC-Pharmacy Technician - STATE_MI State of Michigan Upon Hire

Benefits

Comprehensive benefits package to meet your financial, health, and work/life balance goals.

On-demand pay program powered by Payactiv

Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

Optional identity theft protection, home and auto insurance, pet insurance

Traditional and Roth retirement options with service contribution and match savings

Company

Corewell Health

Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team

Founded in 2022

Grand Rapids, Michigan, USA

10001+ employees

https://corewellhealth.org

H1B Sponsorship

Corewell Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (49)

2024 (11)