FairosRx Member Advocate
New
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The OccuNet CompanyHealthcare
Onsite or hybrid in Amarillo, TX or remote based on experience and business needs., Monday to Friday 12:00 PM – 9:00 PM CSTFull-Time
Salary not disclosed
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Job Details
- Required Skills
- Customer serviceMicrosoft OfficeCritical thinkingActive listeningHIPAA
Requirements
- High school diploma or equivalent required.
- Previous experience in pharmacy benefit management (PBM) is strongly preferred.
- Pharmacy technician, healthcare, insurance, customer service, or call center experience highly valued.
- Member-focused mindset with a passion for improving the member experience.
- Highly effective verbal and written communication skills.
- Demonstrates teamwork by collaborating effectively with peers and cross-functional teams.
- Strong computer skills, including Microsoft Office.
- Ability to quickly learn new systems and technology.
- Ability to multitask, manage time efficiently, and stay organized in a fast-paced environment.
- Excellent active listening, problem solving, and critical thinking skills.
Responsibilities
- Provide clear, empathetic assistance to members regarding pharmacy benefits, formulary coverage, copays, prior authorizations, and medication access.
- Support pharmacies in resolving claim processing questions or issues.
- Work with providers to assist with prior authorizations and drug coverage information.
- Identify claims requiring action, initiate outbound outreach, and resolve issues efficiently.
- Handle complex or sensitive cases with professionalism and follow escalation pathways when needed.
- Verify required data elements on every interaction and adhere to HIPAA and internal privacy policies.
- Document all interactions through the ticketing system according to the procedures set by the department.
- Engage in call quality reviews, incorporate feedback, and apply coaching to improve performance.
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