Customer Service Drug Program Specialist

Customer Service Drug Programs Specialist

Under the direction of leadership, the Customer Service Drug Programs Specialist acts as the customer service liaison with the Blue Cross and Blue Shield of Kansas (BCBSKS) Pharmacy Team and BCBSKS's Pharmacy Benefit Manager (PBM). The Customer Service Drug Programs Specialist assists customer service employees with their job duties, such as responding to customer inquiries and resolving issues or complaints, related to drugs administered through the PBM.

This position is eligible to work onsite or hybrid (9 or more days a month onsite), in accordance with our Telecommuting Policy. Applicants must reside in Kansas, Missouri or be willing to relocate to another approved state as a condition of employment.

Responsibilities include :

Support internal customer service clients by answering drug related questions and coordinating with other areas and external entities to resolve inquiries and improve the customer experience.

Proactively identify opportunities to improve the customer experience relating to drug benefits and PBM experiences, and report issues and complaints to management, Special Investigations Unit, BCBSKS pharmacy team and / or Pharmacy Benefit Manager (PBM) contacts.

Serve on drug related teams as a Subject Matter Expert (SME) on behalf of customer service.

Communicate formulary changes, FDA or drug company recalls, pharmacy terminations, and other drug related topics to Customer Service.

Review and provide feedback relating to implementation of utilization management programs.

Load prior authorizations (PAs) / overrides to Pharmacy Benefit Manager (PBM) claim system.

Perform drug claims and PA testing.

Develop and modify Knowledge Management Tool content.

Facilitate learners through prescription drug training courses via hybrid and virtual modes of communication.

Review logged complaints for Pharmacy Benefit Manager (PBM) drug benefits. Report information to quarterly Pharmacy Review and Quality Assurance (PRQA) team meeting.

Review and suggest improvements of member letters and communications relating to annual pharmacy changes and other drug related issues.

Review Pharmacy Benefit Manager (PBM) claims remediation for accuracy and communicate details and payment information to BCBSKS accounting and claims departments.

Perform claims testing to verify utilization management and other formulary changes are implemented correctly.

Review Custom Group requests and advise if requested benefits can be administered successfully by BCBSKS and Pharmacy Benefit Manager (PBM).

Review membership / claims issues submitted through the Benefits Communication Team and provide guidance and data relating to drug benefits.

Knowledge / Skills / Abilities include :

Effective communication skills to build relationships. Provides guidance and direction in a clear, concise, and professional manner.

Ability to interact positively with internal customers / coworkers and external vendors while demonstrating empathy, adaptability, problem-solving, and listening skills.

Exercise sound business judgment in a team environment and independently, while having the motivation and interpersonal skills necessary to effectively resolve problems and build relationships.

Strong analytical and problem-solving skills.

Strong written and verbal skills to effectively communicate drug content to customer service employees.

Excellent time management skills with a proven ability to meet deadlines.

Basic mathematical skills to assist customer service employees with dosage / quantity / day supply / packaging concerns.

Education and Experience required :

High school diploma or equivalent.

Two years of experience working with BCBSKS drug inquiries to include knowledge of drug utilization management programs, benefits, and claims adjudication through BCBSKS's Pharmacy Benefit Manager (PBM).

Preferred :

Previous experience in the pharmaceutical industry.

Physical Requirements :

Use a personal computer in a stationary position at least 95 percent of the workday.

Benefits & Perks :

Base pay is only one component of your competitive Total Rewards package :

Incentive pay program (EPIP)

Health / Vision / Dental insurance

6 weeks paid parental leave for new mothers and fathers

Fertility / Adoption assistance

2 weeks paid caregiver leave

5% 401(k) plan matching

Tuition reimbursement

Health & fitness benefits, discounts and resources

Our Commitment to Connection and Belonging :

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.