Pharmacy Customer Service Advocate

The Pharmacy Customer Service Advocate assists members, providers, and pharmacies with inquiries for member's eligibility, claim status, precertification requirements, and claims coverage questions by phone, fax, email, and US mail, working independently within the scope of their duties. The Customer Service Advocate coordinates the handling of numerous daily, time-sensitive functions required to maintain an efficient workflow and direct all matters to a proper resolution.

Job Responsibilities:

• Maintain HIPAA/PHI guidelines to ensure the confidentiality of all calls and documents
• Interpret plan documents/plan guidelines
• Determine eligibility by reviewing, researching, and analyzing information in the appropriate system
• Use critical thinking and reasoning to manage workload with above average level
• Maintain and enter information into systems as information is received
• ...