Client Services Pharmacy Support Analyst

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.   

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” 

 

The CS Client Services Pharmacy Support Analyst are part of the front-line team at Capital BlueCross(“CBC”) and are responsible for handling all customer inquiries through multiple channels. Inquiries are received via Internet, digital communications, E-Mail, phone calls and Internal Facets Routing Queues. A complete and thorough understanding of all lines of business is required to support this initiative. Team members are also expected to provide technical, statistical, and administrative support to the supervisor and/or manager of the assigned unit.

 

The CS Client Services Pharmacy Support Analyst is responsible to conduct research and provide problem-solving support to the Brokers and Sales serving the Small, Large and Major Market Groups as well as our Individual Account plans. Technical and administrative support as well as serving as a liaison to the PBM contacts in regards to our plan benefits and policy issues. Responsible for reviewing, identifying and analyzing policies, procedures and contract issues that impact both departmental and/or Plan wide functions/operations. Prepare recommendations on all issues; root cause, action steps and monthly reports.

 

This position is responsible for providing efficient, courteous, professional quality service to Groups, Plan personnel and Brokers/Sales in a timely manner.-Ensures compliance with organizational and regulatory requirements. Topics pertaining to enrollment, billing, benefits, and claims for various types of coverage offered by Capital BlueCross Traditional, POS, PPO, HMO and Medicare Supplemental Programs. Knowledge of Medicare, PPACA, Healthy PA, CHIP, prescription, dental, vision, Chiropractic, Disease Management, Benefits Management, and other programs administered/supported by Capital BlueCross and Avalon

Responsibilities and Qualifications

Researches and analyzes the customer's inquiries as related to one of our Pharmacy LOB.  Determines appropriate action by reviewing and interpreting applicable policies/procedures that are within the established regulatory requirements.  Utilizes the PC, manuals, online reference materials, Imaging, etc., to obtain benefits, enrollment and claim information.

Customer-Focus:

• Manage telephone, electronic, and face-to-face interactions professionally, efficiently and with excellent communication skills
• Effectively present and discuss the products and services to external and internal customers with integrity and understanding and accuracy with every interaction
• Focus on customer retention through first call resolution of concerns
• Establish and maintain positive relationships with customers on behalf of the company by taking personal and complete responsibility for each customer interaction
• Ensure all customers’ needs are completely met, timely, without elevation if possible
• If business needs permit, support the efforts of CBC sales representatives by conducting onsite and/or community-based educational meetings

Ensures the satisfactory resolution of routine and complex Pharmacy inquiries including, but not limited to, benefits, claim filing and processing, collection issues,  enrollment discrepancies, legal requests, Medicare Secondary Payer, and payment requests, Third Party Administrators, COBRA, reinstatements, conversions, refunds, new enrollment, transfer situations, student certifications, handicapped dependents, for all lines of business administered and supported by Capital BlueCross and Avalon. Conducts specific job related instructional sessions as requested by Supervisor.

 

Be able to prioritize work, communicate and share information with the team as necessary.

Respond to customers inquiries via telephone, correspondence, on-site, Fax, Secure IT, E-mail and personal interviews