Job Description

Job Summary
Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. Handles inbound and outbound calls with customers, physician offices, patients or third-party providers about the company’s products or services following standard SOPs and procedures, working under direct supervision. Ensures all contacts receive efficient and courteous service.

Job Responsibilities

Respond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls.
Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes all available information to choose the best solution and resolve customer and PBM concerns.
Requests and loads PBM and/or Major Medical insurance plans.
Processes all non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorization.
Assists physicians in the prior authorization process including initiation of prior authorizations.
May be cross-trained and/or work on Major Medical (MM) and Specialized PBM Plans.
Verifies benefits for Major Medical via online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claims.
Resolves questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilizes all available information to choose best solutions and resolves customer and plan covers.
Facilitates the reimbursement windshields for PBM major medical claims.
Identifies and assesses individual customer or patient needs and provide education on or assist with grant applications, complex funding needs, commercial copay assistance enrollment along with appropriate action to satisfy those needs.
Provides primary support and expertise for specialized programs such as the patient assistance program or special handling.
Manages Pharma requirements including but not limited to warm transfers, bridge/quick start, enhanced prior authorization and appeal support.
May administer order queue such as Submission Problems or Waiting for Payment.
Documents contact interactions, records details, complaints, comments, and actions taken.

About Walgreens
Founded in 1901, Walgreens (www.walgreens.com) has a storied heritage of caring for communities for generations, and proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico, and leading omni-channel platforms. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for retail pharmacy and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

Walgreens is the flagship U.S. brand of Walgreens Boots Alliance, Inc. (Nasdaq: WBA), an integrated healthcare, pharmacy and retail leader. Its retail locations are a critical point of access and convenience in thousands of communities, with Walgreens pharmacists playing a greater role as part of the healthcare system and patients’ care teams than ever before. Walgreens Specialty Pharmacy provides critical care and pharmacy services to millions of patients with rare disease states and complex, chronic conditions.

The actual salary an employee can expect to receive, plus bonus pursuant to the terms of any bonus plan if applicable, will depend on experience, seniority, geographic location, and other factors permitted by law. To review benefits, please visit jobs.walgreens.com/benefits More Company information is available at www.walgreensbootsalliance.com

External Basic Qualifications

High school diploma/GED
Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in healthcare, specialty pharmacy, PBM, call center setting or other related industry
Ability to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential manner
Basic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).

Preferred Qualifications

Experience with providing customer service related to adherence, complex disease states quality, After Call Work (ACW), etc.
Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
Intermediate level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).

We will consider employment of qualified applicants with arrest and conviction records.
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