Customer Service Drug Program Specialist

This job was posted by https://www.kansasworks.com : For moreinformation, please see: https://www.kansasworks.com/jobs/13422105 Underthe direction of leadership, The Customer Service Drug ProgramsSpecialist acts as the customer service liaison with the Blue Cross andBlue Shield of Kansas (BCBSKS) Pharmacy Team and BCBSKS\'s PharmacyBenefit Manager (PBM). The Customer Service Drug Programs Specialistassists customer service employees with their job duties, such asresponding to customer inquiries and resolving issues or complaints,related to drugs administered through the PBM.\"This position is eligible to work onsite or hybrid (9 or more days amonth onsite), in accordance with our Telecommuting Policy. Applicantsmust reside in Kansas, Missouri or be willing to relocate to anotherapproved state as a condition of employment.\"Why Join Us?Family Comes First: Total rewards package that promotes the idea offamily first for all employees; including paid time off and family firstleave.Professional Growth Opportunities: Advance your career with ongoingtraining and development programs both through our internal BlueUniversity and external opportunities.Dynamic Work Environment: Collaborate with a team of passionate anddriven individuals.Make a Positive Impact: Your work will directly contribute to the healthand well-being of Kansans.Stability: 80 years of commitment, compassion, and communityNetworking Opportunities: Participate in our corporate intern programand network with other interns at BCBSKS to enhance your learningopportunity.Compensation\$27.08- \$33.80Non- Exempt 13Blue Cross and Blue Shield of Kansas offers excellent competitivecompensation with the goal of retaining and growing talented teammembers. The compensation range for this role is a good faith estimate,it is estimated based on what a successful candidate might be paid. Alloffers presented to candidates are carefully reviewed to ensure fair,equitable pay by offering competitive wages that align with theindividual\'s skills, education, experience, and training.Are you ready to make a difference? Choose to work for one of the mosttrusted companies in Kansas.****What you\'ll do**Responsibilities Support internal customer service clients by answering drug relatedquestions and coordinating with other areas and external entities toresolve inquiries and improve the customer experience. Proactively identify opportunities to improve the customerexperience relating to drug benefits and PBM experiences, and reportissues and complaints to management, Special Investigations Unit,BCBSKS pharmacy team and/or Pharmacy Benefit Manager (PBM) contacts(including but not limited to Clinical Drug Review Team, MedicalPharmacy Solutions Team, Specialty Team, Clinical Programs team,Client Engagement Team, etc.). Serve on drug related teams as a Subject Matter Expert (SME) onbehalf of customer service. Communicate formulary changes, FDA or drug company recalls, pharmacyterminations, and other drug related topics to Customer Service. Review and provide feedback relating to implementation ofutilization management programs. Load prior authorizations (PAs)/overrides to Pharmacy BenefitManager (PBM) claim system. Perform drug claims and PA testing. Develop and modify Knowledge Management Tool content. Facilitate learners through prescription drug training courses viahybrid and virtual modes of communication. Review logged complaints for Pharmacy Benefit Manager (PBM) drugbenefits. Report information to quarterly Pharmacy Review andQuality Assurance (PRQA) team meeting. Review and suggest improvements of member letters and communicationsrelating to annual pharmacy changes and other drug related issues. Review Pharmacy Benefit Manager (PBM) claims remediation foraccuracy and communicate details and payment information to BCBSKSaccounting and claims departments. Perform claims testing to verify utilization management and otherformulary changes are implemented correctly. Review Custom Group requests and advise if requested benefits can beadministered successfully by BCBSKS and Pharmacy Benefit Manager(PBM). Review membership/claims issues submitted through the BenefitsCommunication Team and provide guidance and data relating to drugbenefits.**What you need**Knowledge/Skills/AbilitiesEffective communication skills to build relationships. Provides guidanceand direction in a clear, concise, and professional manner.Ability to interact positively with internal customers/coworkers andexternal vendors while demonstrating empathy, adaptability,problem-solving, and listening skills.Exercise sound business judgment in a team environment andindependently, while having the motivation and interpersonal skillsnecessary to effectively resolve problems and build relationships.Strong analytical and problem-solving skills.Strong written and verbal skills to effectively communicate drug contentto customer service employees.r