Pharmacy Customer Service Representative (temporary Position)

Pharmacy Customer Service Representative

We are seeking a dedicated and detail-oriented Pharmacy Customer Service Representative for a temporary assignment starting October 5, 2025, supporting both Medicare and Non-Medicare pharmacy customer service operations. This role involves handling sensitive member information with integrity while delivering efficient, accurate, and compassionate service to a wide range of customers including members, providers, agents, and internal teams. This position has a possibility of transitioning to a permanent role after February 28, 2026.

Hours of Operation:

• Medicare Support:
• Open Enrollment (Oct 1 – Mar 31): 7 days/week: 8:00 AM – 8:00 PM
• On-Call: After 8:00 PM (Mon–Sun)
• Non-Open Enrollment (Apr 1 – Sep 30): Mon–Fri: 8:00 AM – 8:00 PM
• Sat: 8:00 AM – 12:00 PM
• On-Call: After 8:00 PM (weekdays) and after 12:00 PM (Saturdays)
• Non-CARE Support:
• Mon–Thu: 7:30 AM – 7:00 PM
• Fri: 9:00 AM – 5:00 PM
• Sat: 8:30 AM – 12:00 PM

Holiday coverage may be required.

Job Summary

While maintaining the integrity of the sensitive information of our membership, a Pharmacy Customer Service Representative is to provide efficient and accurate responses to external customers including physicians staff, pharmacy providers, members, agents and internal team members regarding health plan benefits including accessing services, resolving complex problems, pharmacy claim rejections and overrides, group and member eligibility problems, and other non-routine questions. Educates customers on drug formulary guidelines, including drug formulary alternatives and prior authorization criteria. Consistently create an exceptional experience with each contact, via inbound and outbound calls, face-to-face interactions, online chat, fax, email, etc.

Essential Functions

• Demonstrates high competency in analyzing, evaluating, and responding to complex pharmacy benefit inquiries from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products within departmental guidelines.
• Utilizes clinical knowledge from pharmacy experience or education to be able to effectively discuss covered alternatives to find less expensive options on the formulary to treat diagnosis.
• Collaborates with internal and external resources, promptly provides customers with information and education concerning the drug formulary and prior authorization (coverage determination) requests and ensuring they are completed in a timely manner in accordance with NCQA & CMS requirements.
• Recognizes customer concerns, grievances, and appeal rights resolving or escalating to the proper channels to achieve positive outcomes promptly.
• Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as corporate values and codes of excellence.
• Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements.
• Documents all service interactions with customers within appropriate systems according to guidelines.
• Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule.

Qualifications Required

• High School Diploma or equivalent
• 1 year of relevant experience customer-facing service on phone or face to face; customer service, high volume call center, insurance environment relevant to benefits or managed health care
• 2 years of relevant experience Pharmacy technician experience, pharmacy billing or claim adjudication

Preferred

• Associate's Degree
• Certified Pharmacy Technician from the PTCB Pharmacy Technician Certification Board
• Licensed Pharmacy Technician

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.