Member Care Advocate at TrueScripts Management Services

Description

What We’re About…TrueScripts Management Services is a pharmacist-founded, fully transparent Prescription Benefit Manager that has been revolutionizing the PBM industry since 2014. Our mission is to build lasting relationships by providing prescription benefit expertise at a personal and customized level to ensure optimum value at the lowest possible cost. We are committed to lowering prescription drug spending, achieving clinically effective outcomes, and always delivering Amazing Care. Did we mention Amazing Care? Good! Because this is so much more than just our tagline. It is the foundation upon which our business was built. We believe that Amazing Care starts from within, and our culture is reflective of this philosophy.

Our team members enjoy:

• A wide range of health insurance options including medical, dental and vision
• A strong salary and bonus program
• A robust 401k and company match
• Truescripts is transitioning to an ESOP, a team member owned company! Each year team members are allocated shares of stock through our ESOP, a Qualified Retirement plan!
• A wellness program including financial incentives, chiropractic and massage services, and fitness stipends
• A cohesive, family-based culture
• Charitable contributions and volunteer time

Ok, enough about us. Here’s what we need from you: A future team members' values need to align with TrueScripts' core values of Integrity, Respect, Innovation, and 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. 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.
 

Position Overview:

The Member Care Advocate is responsible for performing all tasks relative to in-house and external communications with TrueScripts members, doctor’s offices’ and pharmacies. This position responds to member and client inquiries, assists members with appropriate prescription benefits, and problem solves any issues in our claims system. The role provides administrative support to Member Care Leadership, Client Success & Executive teams. 

Primary Roles and Responsibilities:
 

Account Inquiries & Claims Processing 

• Assist TrueScripts' members with pharmacy claims processing and plan benefits
• Receive phone calls/emails from members, clients, pharmacies and/or physician offices 
• Troubleshoot claim processing problems and/or inquiries in claims adjudication system 
• Respond to website inquiries 
• Become proficient in all aspects of claims adjudication system 
• Communicate escalated member service concerns to manager 

Account Support 

• QA testing for client transitions/changes 
• Complete pharmacy contact sheet for fax notifications 
• Claims Logging, Invoicing & Reporting  
• Log Specialty Care, Brand Care, Paper Claims, and Fee for Prior Authorizations on SharePoint  
• Log Specialty and Non-Specialty Prior Authorization approvals on SharePoint  
• Prepare and send weekly/monthly invoices to the Accounting team  
• Document actions and outcomes in the client database  

Requirements

Education:

• High School Diploma, 2-year college degree in related field preferred 

Experience/Knowledge:

• Two years of applicable experience preferred  
• Pharmacy technician or equivalent experience preferred  
• Innovative thinking 
• Ability to explain plans to members and partnered pharmacies 
• 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)