Pharmacy Benefits Assistant Account Manager

ESSENTIAL DUTIES AND RESPONSIBILITIES

Respond to escalated member requests and inquiries

• Assist members with prescription coverage questions, claim denials, appeals, and reimbursement processes.
• Help resolve issues related to medication access, generic substitutions, mail-order services, and specialty drugs.
• Provide guidance on benefit design, copays, deductibles, and out-of-pocket maximums for prescription drug plans.

Manage call center information and systems

• Maintain accurate records of member interactions, benefit details, and program data within the agency management system and call center software.
• Obtain and verify prescription plan information, utilization data, and formulary updates from PBMs and carriers.
• Ensure all communications, documents, and benefit information are filed securely and in compliance with HIPAA and other regulations.

Development of program deliverables and improvements

• Create member communication materials tailored to prescription drug benefits, such as educational guides on using the program
• Support the collection, auditing, and distribution of performance reports on prescription drug utilization, costs, and trends for employer clients.
• Contribute to annual reporting on prescription benefit program effectiveness, including stewardship reports for self-funded plans.

Perform other job-related duties as required.

EDUCATION AND/OR EXPERIENCE

• Associate's degree in a related field.
• 3+ years of related experience and/or training.
• Equivalent combination of education and experience.