Pharmacy Benefit Manager Resume Samples

Description :

1. Responsible for answering 50 to 100 inbound calls daily from members to -Refill prescriptions -Send out requests to Dr.
2. Helped guide members through their benefits information (Deductible, Out of pocket, etc.) and answered questions appropriately.
3. Escalated callers with drug-related questions to the Pharmacist.
4. Provided quotes to members with an estimated cost of medications when using Prime Mail, mail order pharmacy vs. local pharmacy.
5. Awarded multiple certificates for very satisfied surveys from members.
6. Met all performance goals such as first call resolution, quality calls, and customer satisfaction, all while providing world-class customer service.
7. Answered inbound calls from pharmacies and doctor offices.

Experience

5-7 Years

Level

Executive

Education

High School Diploma

Description :

1. Directed daily operations of Member Services Contact Center ensuring member and client satisfaction and retention.
2. Directed management to maintain consistent service levels utilizing scheduling efficiencies.
3. Responsible for smooth implementation of new groups support existing strategies while seeking improvements of same for improved client retention.
4. Connected with employees at all levels seeking new ideas and rewarding same.
5. Maintained internal program to ensure service excellence at a consistently high level.
6. Consistently met or exceeded organizational goals for call volume, response time, and satisfaction; exceeds performance guarantees including an ASA under 30; abandons under 3% and First Call Resolution of 98%.
7. Streamlined call center staffing inspiring or moving out under-performers, adding levels that created internal positions for growth rewarding those who perform at high levels.

Experience

5-7 Years

Level

Executive

Education

GED

Description :

1. Presented Facility Coordinator Perform administrative and clerical tasks that include invoicing, purchasing of facility supplies, custodial supplies, monitor copy machines, and process work orders.
2. Coordinated the Fire and Shelter in Place Drills once a year with the Safety team of ESI-Pueblo.
3. Conducted New Hire Employee Orientation for Facilities/Safety.
4. Processed incoming and outgoing US Postal Services, FedEx, UPS, and Staples deliveries.
5. Maintained and issued keys to new and existing employees for offices and furniture.
6. Operated, maintained, and arranged all service for mailing equipment including postage meter, copy machines, biohazardous equipment, and all vending machines.
7. Coordinated with the Facility Manager to put forth the demands, difficulties, and suggestions of the workers.

Experience

2-5 Years

Level

Executive

Education

BS

Description :

1. Claims Auditor Assisted United Health Care/AARP members with ordering medications through the mail-order pharmacy.
2. Refilled medications, Send PSC request to members doctors if they need new prescriptions.
3. Handled calls in high call volume in a timely manner.
4. Claims Auditor completed claims for retail pharmacies and mail order.
5. Provided accurate and appropriate information in response to customer inquiries.
6. Properly directed inbound calls in phone queues to improve call flow.
7. Helped support the HR/Facilities department with special projects.

Experience

2-5 Years

Level

Executive

Education

G.E.D

Description :

1. Temporarily assigned as a pharmacy benefit manager.
2. Provided accurate information on insurance benefits for pharmaceuticals.
3. Knowledgeable of HIPPA laws, policies, and procedures to ensure quality customer service.
4. Facilitated resolution on calls with issues regarding drug coverage.
5. Maintained proper documentation of every call for future reference.
6. Effectively resolved insurance rejections and other billing issues.
7. Performed technical processes required to dispense medications to patients.

Experience

5-7 Years

Level

Executive

Education

AS in Accounting

Description :

1. Effectively communicated within our team and with the client was vital to the success of each project.
2. Created PowerPoint presentations for meetings.
3. Learned PBM business operations through OJT and classroom training for departments within Med-Impact.
4. Assisted the pharmacists with checking in and pricing drug orders, third party transactions, and relevant paperwork.
5. Worked closely with Pharmacy Care Representatives (PCRs) in providing excellent patient care.
6. Improved management of departmental costs by better monitoring of call flows.
7. Implemented call center splits for improved efficiency, implemented training initiatives for improved service Implemented and expanded training program, adding key elements that ensured high-quality expectations Successfully lead the implementation of new ACD system for contact center Expanded existing call center to 3 times its size in response to growing business needs while maintaining a high level of service expectations.

Experience

2-5 Years

Level

Executive

Education

High School Diploma

Description :

1. Helped guide pharmacies with running claims correctly using the RxClaims system.
2. Assisted pharmacies with claim rejections.
3. Coordinated with HR to let the former employee know the time limit to retrieve personal belongings.
4. Get directly involved when needed.
5. Actively managed financial performance.
6. Ensured accountability for results.
7. Conducted sophisticated analyses of potential savings for BMS with consideration of the customers perspective of contracted versus non-contracted revenue and works closely with the RAE/NAE and integrated customer team to evaluate appropriate options and strategies for leveraging additional value-creating opportunities.

Experience

2-5 Years

Level

Junior

Education

GED

Description :

1. Assisted in probing and decoding of medical billing issues Offered solutions to issues by researching and clarifying.
2. Answered pharmacy calls about MBR benefits helped pharmacy process claims gave information about the MBR plan Accomplishments 100% on quality better.
3. Adjudicated claims to ensure payment Compiled pharmacy benefits information and assistance to existing pharmacy members Administered customers.
4. Managed billing information for all patients, create work schedules, schedule/conduct interviews, gather patient information for over 300 facilities, .
5. Trained employees on procedures, new software, and created training documents for future new-hires.
6. Acted as a liaison for all departments and serves as a subject matter expert to the Call Center.
7. Processed pharmacy claims Administer rebates Communicate with patients and physicians.

Experience

2-5 Years

Level

Executive

Education

Master's In Counseling

Description :

1. Effectively expressed ideas and information in writing and verbally to individuals and groups at all levels using two-way communication and a high impact communication style.
2. Demonstrated skill in organizing, leading, and inspiring individuals toward the pursuit of customer satisfaction in a rapidly changing environment.
3. Driven disciplined, fact-based decisions.
4. Driven change and innovation through continually seeking and implementing innovative solutions; thrive on continuous change; inspire people to stretch beyond their comfort zone; take well - reasoned risks on 'what has always been done' and change direction, as required.
5. Modeled and demanded integrity and regulatory compliance.
6. Executed with discipline and urgency; drive exceptional performance.
7. Delivered value to the customer.

Experience

2-5 Years

Level

Junior

Education

G.E.D

Description :

1. Provided strategic planning, direction, and leadership in direct support of UnitedHealthcare Employer & Individual integrated medical & pharmacy growth and retention initiatives for existing OptumRx. 
2. Integrated accounts, as well as certain standalone pharmacy clients where UnitedHealthcare Employer & Individual segments have an existing or targeted relationship.
3. Understood the competitive landscape and effectively position pharmacy management programs, participating as account management lead for pharmacy in best and final meetings, industry forums, broker and consultant meetings.
4. Implemented effective pharmacy strategy and goals which are aligned with and supportive of those of the company and our customers.
5. Networked, collaborated and consensus built.
6. Used internal networks to get things done.
7. Utilized the assistance of others who have a stake in the outcome and proactively participate in achieving customer satisfaction and service performance in a continually changing environment.

Experience

2-5 Years

Level

Executive

Education

GED