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Pharmacy Services Specialist
JOB SUMMARYThe Pharmacy Services Specialist 1 communicates with members, providers and clients to discuss benefits of the Health Plan Pharmacy services, makes determinations and enters prior authorizations based on criteria met and resolves claims processing and eligibility issues while following department policies and procedures. Works on the customer?s behalf, as well as, being a liaison of the Health Plan to find root cause issues to address concerns that are brought forward by the customer.ESSENTIAL FUNCTIONS OF THE ROLE Helps customers, by phone or through written correspondence, to satisfactorily solve claims processing issues for all HealthPlan lines of business, utilizing the pharmacy claims processing


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