At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Customer Care Specialist Sr

Job Description

The Senior Customer Care Specialist is responsible for delivering exceptional support to members and providers by addressing inquiries related to eligibility, benefits, claims, and service authorizations. The role serves as a subject matter expert and resource for complex issues, ensuring accurate and timely resolution while maintaining a high standard of service.

Responsibilities

  • Engage inbound callers professionally; actively listen and probe to determine the purpose of the call and resolve administrative concerns, including claims and dissatisfaction
  • Research and communicate member information such as eligibility, benefits, Employee Assistance Program (EAP) services, claims, and authorizations while maintaining confidentiality
  • Identify and escalate operational inefficiencies; ensure follow-up to fully meet member or provider needs and support continuous improvement
  • Support team development by mentoring new staff and participating in initiatives that enhance Care Center performance and culture
  • Initiate care programs by accurately assembling and entering patient data into appropriate systems for EAP, Care, and Utilization Management
  • Educate providers on claims submission, treatment plans, and appeal processes to ensure proper procedures are followed
  • Respond to crisis calls and assist clinicians until resolution, ensuring appropriate support is provided
  • Make routine referrals and triage decisions, including directing callers to appropriate teams or resources and providing reimbursement and network information
  • Other duties as assigned

Minimum Qualifications

  • High school diploma from an accredited school or equivalent GED
  • 2 years of work experience in customer service

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

  • Must be flexible in scheduling and comfortable with change
  • Strong typing proficiency (avg. 35+ WPM) with strong written and verbal communication skills
  • Demonstrated ability to multi-task and maneuver through various computer platforms while verifying information on all calls
  • Familiarity with medical terminology, healthcare procedures, and insurance-related language to effectively support member and provider inquiries
  • Knowledge of HIPAA regulations and other healthcare compliance standards

Preferred Qualifications

  • 3 years work experience in customer service in healthcare
  • Previous experience with Genesys or CRM technology platforms

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $19.23 - $28.85 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. 

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.