Customer Care Associate I
Budget / Salary$17.85–25.48
TypeFull-time job
LocationUnited States
Posted2 hours ago
At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting Title
Customer Care Associate IJob Description
The Customer Care Specialist is responsible for providing exceptional support to members and providers by addressing inquiries related to eligibility, benefits, claims, and service authorizations. The role involves handling incoming calls, accurately documenting intake information into designated systems, and delivering outstanding customer service to both internal and external stakeholders. The goal is to resolve member and provider needs efficiently, ideally on the first call and consistently meet or exceed established performance standards for quality and productivity.
Responsibilities
Engage inbound callers professional; actively listen and probe to determine the purpose of the call and resolve administrative concerns, including claims and dissatisfaction
Make outbound calls to solve member issues (e.g., billing issues with a Pharmacy) or additional information needed for a prior authorization
Research and communicate member information such as eligibility, benefits, Employee Assistance Program (EAP) services, claims, and authorizations while maintaining confidentiality
Initiate care programs by accurately assembling and entering patient data into appropriate systems for EAP, Care, and Utilization Management
Educate providers and members on claims submission, treatment plans, appeal processes, and reimbursement rates across multiple networks
Identify and respond to crisis calls, assisting clinicians until resolution; make routine referrals and triage decisions not requiring clinical judgment
Support continuous improvement by identifying operational inefficiencies, performing follow-up tasks, and ensuring member/provider needs are fully met
Document interactions thoroughly; forward necessary information to appropriate staff and refer provider-related inquiries to the correct teams
Other duties as assigned
Minimum Qualifications
High school diploma from an accredited school or GED
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
Must be flexible in scheduling and comfortable with change
Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills
Demonstrated ability to multi-task and maneuver through various computer platforms while verifying information on all calls
Ability to thrive in high-volume call center environments, managing a large number of inbound and outbound calls efficiently
Familiarity with medical terminology, healthcare procedures, and insurance-related language to effectively support member and provider inquiries
Knowledge of HIPAA regulations and other healthcare compliance standards
Preferred Qualifications
Prior experience in a healthcare or insurance call center environment
Previous customer service experience
Previous experience with Genesys and CRM technology platforms
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.
Potential pay for this position ranges from $17.85 - $25.48 based on experience and skills.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.
Originally posted on Himalayas
Job Posting Title
Customer Care Associate IJob Description
The Customer Care Specialist is responsible for providing exceptional support to members and providers by addressing inquiries related to eligibility, benefits, claims, and service authorizations. The role involves handling incoming calls, accurately documenting intake information into designated systems, and delivering outstanding customer service to both internal and external stakeholders. The goal is to resolve member and provider needs efficiently, ideally on the first call and consistently meet or exceed established performance standards for quality and productivity.
Responsibilities
Engage inbound callers professional; actively listen and probe to determine the purpose of the call and resolve administrative concerns, including claims and dissatisfaction
Make outbound calls to solve member issues (e.g., billing issues with a Pharmacy) or additional information needed for a prior authorization
Research and communicate member information such as eligibility, benefits, Employee Assistance Program (EAP) services, claims, and authorizations while maintaining confidentiality
Initiate care programs by accurately assembling and entering patient data into appropriate systems for EAP, Care, and Utilization Management
Educate providers and members on claims submission, treatment plans, appeal processes, and reimbursement rates across multiple networks
Identify and respond to crisis calls, assisting clinicians until resolution; make routine referrals and triage decisions not requiring clinical judgment
Support continuous improvement by identifying operational inefficiencies, performing follow-up tasks, and ensuring member/provider needs are fully met
Document interactions thoroughly; forward necessary information to appropriate staff and refer provider-related inquiries to the correct teams
Other duties as assigned
Minimum Qualifications
High school diploma from an accredited school or GED
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
Must be flexible in scheduling and comfortable with change
Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills
Demonstrated ability to multi-task and maneuver through various computer platforms while verifying information on all calls
Ability to thrive in high-volume call center environments, managing a large number of inbound and outbound calls efficiently
Familiarity with medical terminology, healthcare procedures, and insurance-related language to effectively support member and provider inquiries
Knowledge of HIPAA regulations and other healthcare compliance standards
Preferred Qualifications
Prior experience in a healthcare or insurance call center environment
Previous customer service experience
Previous experience with Genesys and CRM technology platforms
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.
Potential pay for this position ranges from $17.85 - $25.48 based on experience and skills.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.
Originally posted on Himalayas
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