Customer Care Pharmacy Technician (Full-Time)

About Capital Rx 

Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.

Capital Rx has an exciting full-time opportunity for remote candidates in the continental US, with priority given to those in Hawaii. 

Location: Remote 

Shifts: Candidates must be open to working any shift. 

Position Responsibilities: 

• Act as the primary point of contact for incoming member calls, prior authorization inquiries, and ensure appropriate escalation of cases and all intake notes to the Clinical Prior Authorization Team 

• Actively intake a thorough and complete prior authorization request from prescribers and members by asking applicable drug and client-specific clinical questions 

• Accurately advise callers on options for exception requests (formulary, copay, early refill, etc.) based on client benefit elections and provide additional information and status updates to prescribers, members, and pharmacies 

• Efficiently triage incoming calls with professional phone etiquette from members, prescribers, and pharmacies with minimal support. Ask probing questions to identify and resolve all issues and address concerns promptly 

• Act as a valuable resource for Customer Service Representatives supporting member and pharmacy inquiries, stepping in as needed based on demand. Proactively identify, document, and address member and pharmacy concerns to ensure everyone receives the care and attention they deserve 

• Effectively communicate issues and solutions to members, pharmacies, and relevant internal stakeholders to ensure customers receive quality care and that the resolution meets all health and safety standards 

• Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast-paced environment 

• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies 

• Assist with onboarding and training of new team members or temporary staff as needed 

• Support the Fraud, Waste, and Abuse program by reviewing pharmacy claims information and communicating findings to appropriate internal staff 

• Collaborate across different systems while utilizing up to two monitors, efficiently multitasking in a dynamic and fast-paced environment 

• Self-starter who displays a positive attitude, strong work ethic, and excellent attendance 

• Meet all departmental goals including schedule adherence, attendance, and quality monitoring 

• Standard hours for training: Monday thru Friday, 9:00 am – 5:30 pm, Eastern 

• Perform other customer support duties as assigned 

• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance 

 

Required Qualifications: 

• High school diploma or the equivalent; associate or bachelor’s degree preferred 

• A current National Certification as a Pharmacy Technician (CPhT) and a valid license are required 

• 2+ years of pharmacy technician experience in a clinical pharmacy setting PBM, Health Plan, or related Health Care experience required 

• 2+ years of customer service experience with a passion for building customer loyalty through exceptional listening, relationship building, and strong written and verbal communication 

• Experien