Top 1 Insurance Claims and Policy Processing Clerks Jobs in Jacksonville, FL

Pharmacy CSR Bilingual Spanish (Remote, Must Live in Florida)
Molina Healthcare —Jacksonville, FL
- $14.00 - $24.02 an hour
- Full-time
- Remote
- Spanish
- 1 year
- Communication skills
5d

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Pharmacy CSR Bilingual Spanish (Remote, Must Live in Florida)

Molina Healthcare -
Jacksonville, FL

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Job Details

Full-time
$14.00 - $24.02 an hour
5 days ago

Qualifications

Spanish
Phone communication
Spreadsheets
Employee relationship building
Client relationship development
Productivity software

Full Job Description

Molina Healthcare is hiring a Pharmacy Customer Service Representative. This role is remote for those who live in Florida only. Bilingual- Spanish speaking is needed.

Our agents assist with all Medicaid member Pharmacy-related calls. You will assist the members with obtaining their medications. This is a pharmacy call center environment focused on first call resolution and the member's experience.
Pharmacy Reps will be taking calls for the state of FL. Must be bilingual, and live in the state of FL.
Shift times will be Monday through Friday 8:00a - 4:30p or 10:30a-7:00p EST, all dependent on business needs.

Essential Job Duties

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards.
Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies.
Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated.
Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
Assists members and providers with initiating verbal and written coverage determinations and appeals.
Records calls accurately within the pharmacy call tracking system.
Maintains established pharmacy call quality and quantity standards.
Interacts with appropriate primary care providers to ensure member registry is current and accurate.
Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation.
Proactively identifies ways to improve pharmacy call center member relations.

Required Qualifications

At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience.
Excellent customer service skills.
Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc.
Ability to multi-task applications while speaking with members.
Ability to multi-task applications while speaking with members.
Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors.
Ability to meet established deadlines.
Ability to function independently and manage multiple projects.
Excellent verbal and written communication skills, including excellent phone etiquette.
Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

Preferred Qualifications

Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice.
Health care industry experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Same Posting Description for Internal and External Candidates

Pay Range: $14 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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Pharmacy CSR Bilingual Spanish (Remote, Must Live in Florida)

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