Job Description

Job Title: Pharmacy Benefit Representative (Workers\xe2\x80\x99 Compensation/PIP)
Job Status: Full-Time
FLSA Status: Exempt, Salary

Position Summary:
Pharmacy Benefit Representative performs a variety of functions related to workers\xe2\x80\x99 compensation claims and personal injury protection claims; i.e. the prescription, DMEPOS and ancillary benefits. Representative supports various claim processing services including handling client and member inquiries and problem resolutions, performing duties associated with claim adjudication and billing. Functions as a primary resource in providing customer support for injury claim clients and services.

Primary Duties:

• Support multiple client program offerings
• Handling general client inquiries, service calls, and problem resolution, meeting EHIM\xe2\x80\x99s performance standards
• Effectively communicate with multiple parties to complete responsibilities from beginning to end
• Performs benefit authorizations and modification as required and approved by client
• Maintain up to date documentation of communications and activities between EHIM and client and/or member through EHIM system and operations
• Proactively keeps themselves and the department educated on industry trends and developments to accurately communicate to clients
• Performs various related duties and special projects as assigned
• Follows all policies and procedures related to job responsibilities

Position Requirements:

• High school diploma or equivalent required, post high school education preferred.
• Minimum two years\xe2\x80\x99 experience in a customer service position.
• Work experience as a pharmacy technician, DMEPOS provider, claims adjuster, or a similar service position in health care or injury claim industry is preferred.
• Must have excellent communication skills and the ability to work effectively with clients, pharmacies, vendors, and plan members.
• Proficient PC skills in Windows-based applications.
• Possess strong analytical skills and independent thinking/creativity.
• Ability to be flexible and quickly adapt to changing needs within the department.
• Must be highly organized with strong attention to detail.
• Must be flexible with scheduled work hours.
• Ability to work under general direction, on multiple tasks with demanding timelines.
• Managed care background and knowledge of pharmacy terminology desired.

EHIM is an equal opportunity employer, and does not discriminate on the basis of race, color, religion, gender, pregnancy, national origin, age, veteran status, disability, sexual orientation, gender identity/expression, marital status, genetic characteristics and any other factor protected by law.