Member Care Representative -Remote- MCR West

Description: Looking for something BETTER? So were we! That’s why TrueScripts was created. But “better” didn’t stop there. That’s why we’re now looking for YOU! What We’re About… If you are an “A Player” looking for a new challenge, a fulfilling career, and a family-based values company, we welcome the opportunity to meet with you. TrueScripts is a Prescription Benefits Management (PBM) company. We manage prescription plans for self-insured businesses. A potential candidate’s values must match our TrueScripts business core values of Integrity, Respect, Innovation, and Service an inherent trait to always provide a high level of Service. This match in value systems is critical for our team's chemistry and continued success. Our culture is positive, and our people possess a ‘can do, proactive attitude – staying out in front of the curve so that we can best advise our clients of the ever-changing world in prescription management. Honesty and transparency are the foundation that we build upon. What sets us apart from our competitors is the programs that we bring, the education that we provide, and the utmost respect for clients and their members to assist them when and where needed. Our team members enjoy:

• Robust benefits and a strong salary
• ESOP - Team Member Owned
• Employee Assistance Program
• Wellness Program
• Dream Manager Program (yes, it’s a real thing!)
• A cohesive, family-based culture
• Charitable contributions
• Lots of celebrations!

Ok, enough about us. Here’s what we need from you: What you’ll do In a few words Member Care Representative is responsible for performing all tasks relative to in-house and external communications with TrueScripts clients and members. Response to member and client inquiries assists members with appropriate prescription benefits, and the problem solves any issues in the claims system. Provides administrative support to Clinical Care, Account Management & Executive teams. Most importantly-Provide amazing care to those who call and need our help and/or service. The fundamentals for the job

• Account Inquiries & Claims Processing
• Receive phone calls/emails from members, clients, pharmacies, and/or physician offices
• Troubleshoot claim processing problems and/or inquiries in the claims adjudication system
• Respond to website inquiries
• Become proficient in all aspects of the claims adjudication system
• Communicates problems and concerns to the manager
• Clinical Care Support
• Complete new/renewal Prior Authorization requests for specialty & non-specialty drugs
• Reach out to members to assist in a change of Rx to a more cost-effective generic alternative
• Assist members needing copay assistance for brand medications
• Create/mail Brand Care letters
• Account Support
• QA testing for client transitions/changes
• Complete the pharmacy contact sheet for fax notifications
• Performs other duties as assigned

Requirements: What you’re made of The bold requirements

• Customer service experience
• Knowledge of claims processing helpful
• Analytical thinking and attention to detail
• Excellent communication and customer relations skills
• Problem-solving skills
• Ability to multi-task and prioritize in an ever-changing environment
• Strong computer skills including Microsoft Office (Excel, Word, PowerPoint, Outlook)
• High School Diploma and/or college degree in a related field preferred
• Pharmacy technician experience preferred, not required
• * To be considered for this role, applicants must reside in Pacific time zone.

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