Specialty Pharmacy Resolution Expert Tier 2 - Multiple Locations

Position Description:

Welcome to one of the toughest and most
fulfilling ways to help people, including yourself. We offer the latest tools,
most intensive training program in the industry and nearly limitless
opportunities for advancement. Join us and start doing your life's best work.

This role supports PCCs and Tier 1 SMEs with real time solutions for complicated cases
that require off line research and follow up and call de-escalation allowing
Tier 1 Resolution  SMEs to focus on
inbound assistance for PCCs.Primary Responsibilities:Some areas of focus would include:

All Tier 2 Escalations (real-time and/or workbasket)

CRM Escalations

Briova’s
Escalations Team

Office
Based SME support

Resends

Part B

Tier 1 trainingEscalated Calls: 
Responsible for taking over escalated calls to resolve member/providers
issues.  Offer additional options to
provide solutions/positive outcomes for callers.  Responsible for spending coaching’s to agents
as needed.

 

CRM Liaison:

Assist fellow agents with contacting the Client Relations
Managers for the members plan when any issues arise. The issues range from
copay discrepancies to claim rejections.

 

CRM (Client Relations Manager) Escalations:

Responsible for researching the member’s pharmacy benefits
and sending discrepancies to the CRM via SharePoint or email.  Responsible for follow up on issues once
resolved to have claims retrobilled, follow up with member to insure they
understand the benefits.  Responsible for
making sure RXHD is showing the correct benefit information for the member and
if not sending to the CRM to have updated.

 

Office Based Support:

Responsible for providing SME support to the Office Based
PCC staff. This will include the following functions: TBD

 

Part B:

Provide step by step assistance with adding Part B coverage
into the appropriate system so agents are able to set up patient deliveries in
a timely fashion.

 

Resend/Reship: 

Responsible for taking action on saving deliveries,
communicating with UPS, and reaching out to patients advising of the current
delivery status.  Responsible for
attempting to salvage packages by working with our third party courier Dawson
and UPS to intercept the package to successfully deliver to the member. If the
package is not salvageable the Resend/Reship SME is responsible to work with a
Pharmacist and the patient to send out a replacement order directly from the
pharmacy or work with the insurance to have an override approved to fill
locally.

 

Delays:  Responsible
for working with UPS on packages that are delayed due to weather, operating
conditions, and mechanical issues.  The
Resend SME will work will work on outbound calls to the members to advise of
the delay and setup a resend if needed or locate the medication at a local
retail pharmacy and enter the override. 
Resend SMEs are responsible for logging all delayed orders into the UPS
Delay SharePoint and following up to review if a Resend or an override was
needed due to the delay.

 

Replacements: 
Responsible for working with the manufacturer on defective product.
Working as the liaison between the manufacturer and patient/MDO, the Resend SME
is responsible for follow up with fulfillment once the replacement paper work
or product has been received and setting up the delivery with the patient or
MDO. 

Minimum Requirements:HS Diploma/GEDMust have extensive knowledge of the Tier 1 SME role within BriovaRxKnowledge, skills and the ability to de-escalate calls and offer resolution3+ months of experience as a Tier 1 SME within BriovaRxPreferred Qualifications:Prior resends and/or reship experience

OptumRx is
an empowering place for people with the flexibility to help create change.
Innovation is part of the job description. And passion for improving the lives
of our customers is a motivating factor in everything we do.

 

If you're ready to talk about groundbreaking
interactions, let's talk about what happens when a firm that touches millions
of lives decides to gather results from millions of prescriptions every month
and analyze their impact. Let's talk about smart, motivated teams. Let's talk
about more effective and affordable healthcare solutions. This is caring. This
is great chemistry. This is the way to make a difference. We're doing all this,
and more, through a greater dedication to our shared values of integrity,
compassion, relationships, innovation and performance.  Join us and start doing your life’s best work.SMDiversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.