Customer Service Professional - Pharmacy Technician


Call Center and Customer Service

Advert ID




Job Type




Salary Range

Based on Experience

No. of Openings


Branch Information

Raleigh - Durham NC Area - (USA) 430 Davis Drive Suite 100 NC Morrisville , NC 27560 Phone : 855-591-7454



Job Description

We are seeking a Customer Service Professional to join our team! You will be responsible for completion of non-clinical reviews and communication to customers to support the managements reviews and activities, as well as provide support for administrative functions within the department to support turnaround times.


* Conducts non clinical reviews based on applicable criteria and guidelines on requested services. Communicates decision to provider and/or member, according to department protocols.

* Documents outcome of reviews and demonstrates the ability to interpret and analyze the non-clinical information.

* Completes verbal or non-verbal outreach to providers or members to obtain the medical information for the review.

* Identifies and refers organization determinations that require a clinical review to a nurse or Medical Director.

* Conducts reviews of authorizations entered to ensure accuracy to avoid impacting claims payment.

* Supports the care management department by completing outreaches to members or providers to meet The Centers for Medicare & Medicaid Services (CMS) requirement for soliciting information or notification standards.

* Supports the administrative support team with the retrieval and attachment of facsimiles to ensure customer requests are forwarded to the respective area for processing.

* Serves as a subject matter expert for CM&O around the non-clinical review process.


Previous experience in customer service as well as medical field

Three years of health care operations experience

Preference goes to those who understand medical terminology as well as EXP Macess, Amisys and Right-Fax

Ability to build rapport with clients

Ability to prioritize and multitask

Positive and professional demeanor

Excellent written and verbal communication skills