Blue Cross and Blue Shield of Kansas · 4 hours ago
Customer Service Drug Program Specialist
Salina
Full-time
Hybrid
Entry, Mid Level
$26.34/hr - $31.30/hr
2+ years expBlue Cross and Blue Shield of Kansas is seeking a Customer Service Drug Program Specialist to act as the liaison between the Pharmacy Team and the Pharmacy Benefit Manager. The role involves assisting customer service employees with drug-related inquiries, resolving issues, and improving the customer experience.
Financial ServicesHealth Care
Responsibilities
Support internal customer service clients by answering drug related questions and coordinating with other areas and external entities to resolve inquiries and improve the customer experience
Proactively identify opportunities to improve the customer experience relating to drug benefits and PBM experiences, and report issues and complaints to management, Special Investigations Unit, BCBSKS pharmacy team and/or Pharmacy Benefit Manager (PBM) contacts (including but not limited to Clinical & Medical Drug Review Team, Specialty Team, Clinical Programs team, Client Engagement Team, etc.)
Serve on drug related teams as a Subject Matter Expert (SME) on behalf of customer service
Communicate formulary changes, FDA or drug company recalls, pharmacy terminations, and other drug related topics to Customer Service
Review and provide feedback relating to implementation of utilization management programs
Load prior authorizations (PAs)/overrides to Pharmacy Benefit Manager (PBM) claim system
Perform drug claims and PA testing
Develop and modify Knowledge Management Tool content
Facilitate learners through prescription drug training courses via hybrid and virtual modes of communication
Review logged complaints for Pharmacy Benefit Manager (PBM) drug benefits. Report information to quarterly Pharmacy Review and Quality Assurance (PRQA) team meeting
Review and suggest improvements of member letters and communications relating to annual pharmacy changes and other drug related issues
Review Pharmacy Benefit Manager (PBM) claims remediation for accuracy and communicate details and payment information to BCBSKS accounting and claims departments
Perform claims testing to verify utilization management and other formulary changes are implemented correctly
Review Custom Group requests and advise if requested benefits can be administered successfully by BCBSKS and Pharmacy Benefit Manager (PBM)
Review membership/claims issues submitted through the Benefits Communication Team and provide guidance and data relating to drug benefits
Qualification
Required
Effective communication skills to build relationships. Provides guidance and direction in a clear, concise, and professional manner
Ability to interact positively with internal customers/coworkers and external vendors while demonstrating empathy, adaptability, problem-solving, and listening skills
Exercise sound business judgment in a team environment and independently, while having the motivation and interpersonal skills necessary to effectively resolve problems and build relationships
Strong analytical and problem-solving skills
Strong written and verbal skills to effectively communicate drug content to customer service employees
Excellent time management skills with a proven ability to meet deadlines
Basic mathematical skills to assist customer service employees with dosage/quantity/day supply/packaging concerns
High school diploma or equivalent
Two years of experience working with BCBSKS drug inquiries to include knowledge of drug utilization management programs, benefits, and claims adjudication through BCBSKS's Pharmacy Benefit Manager (PBM)
Preferred
Previous experience in the pharmaceutical industry
Benefits
Incentive pay program (EPIP)
Health/Vision/Dental insurance
6 weeks paid parental leave for new mothers and fathers
Fertility/Adoption assistance
2 weeks paid caregiver leave
5% 401(k) plan matching
Tuition reimbursement
Health & fitness benefits, discounts and resources
Company
Blue Cross and Blue Shield of Kansas
Blue Cross and Blue Shield of Kansas is a mutual insurance company provides Health Insurance, Dental Insurance, and Life Insurance.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Matt All
President and CEO
Kevin Cohen
Chief Technology Officer
Recent News
TechTarget
2025-10-31
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