Pharmacy Benefits Customer Representative

Our Vision: Fulfill the essential promise of pharmacy care and help people to live to their healthiest, happiest, and fullest potential.

Summary: This role is responsible for supporting patients, providers, and clients by delivering accurate eligibility determinations, benefit verifications, and specialty medication support within a high-volume environment. This role applies detailed knowledge of Medicare benefits, patient assistance programs, and Federal Poverty Level guidelines to ensure compliance with program requirements and timely access to therapy. Advocates manage complex documentation, medication ordering, adverse event reporting, and client-specific processes while providing empathetic, high-quality customer service. The position requires strong analytical skills, attention to detail, and the ability to navigate multiple systems and workflows efficiently in a fast-paced, highly regulated healthcare setting.

Essential Duties and Responsibilities: Obtain and review required information from program documentation, including financial records and Federal Poverty Level (FPL) guidelines, to determine program eligibility. Calculate Federal Poverty Level (FPL) and assess its impact on eligibility for assistance programs. Conduct benefit verifications, including interpretation of E1 verification responses and identification of differences between commercial and government benefits. Review and determine patient eligibility for Medicare Extra Help and Medicare Savings Programs. Understand, apply, and clearly explain program requirements to customers, including appeal processes. Process orders for complex specialty medications in accordance with program and regulatory requirements. Properly manage and execute applications received through multiple intake channels while ensuring completeness and accuracy. Obtain and document required authorizations and attestations for patient-shipped and provider-shipped complex, client-specific requirements related to adverse event reporting and product quality complaint processes. Capture, document, and escalate complex adverse events and product quality complaints in compliance with program and client guidelines. Support and implement client-specific requirements related to product reshipment or replacement. Follow program rules governing medication distribution, including determining whether medications may be shipped to patients or providers and ensuring appropriate communication protocols are followed. Ensure compliance with prescription scheduling rules and delivery channel requirements, including identifying authorized personnel permitted to order effectively in a cross-trained environment, supporting foundation application eligibility processes and related program functions. Provide excellent customer service by demonstrating empathy, professionalism, and a comprehensive understanding of program processes and requirements. Perform additional duties as assigned.

Preferred: Florida Registered Pharmacy Technician license, in good standing. High school diploma or equivalent.2+ years of experience in patient assistance, healthcare, specialty pharmacy, or a related field. Experience with manufacturer patient assistance programs preferred.

Knowledge, Skills and Abilities: Spanish Bilingual a bonus. Knowledge of healthcare assistance programs, including Medicare benefits and the application of program eligibility requirements. Understanding of Medicare Extra Help and Medicare Savings Programs and their impact on patient eligibility. Ability to conduct and interpret benefit verifications across commercial and government insurance plans. Strong analytical skills with the ability to apply program rules, Federal Poverty Level (FPL) guidelines, and financial documentation to eligibility with pharmacy benefit structures, including out-of-pocket costs, deductibles, copayments, and prior authorization requirements. Knowledge of specialty medications, including complex handling requirements, assessments, and proper shipping of high-cost therapies. Understanding of adverse event reporting and product quality complaint processes, including required documentation and escalation protocols. Ability to follow and apply client-specific and program-specific rules related to medication ordering, distribution channels, and authorized personnel. Strong attention to detail with the ability to accurately process applications, authorizations, and attestations across multiple intake channels. Effective verbal and written communication skills to clearly explain program requirements, appeal processes, and next steps to customers. Ability to deliver professional, empathetic, and high-quality customer service in a high-volume, fast-paced contact center environment. Ability to manage multiple systems, shifting priorities, and time-sensitive tasks while maintaining compliance and quality standards. Follow HIPAA and PHI Compliance. Work Environment / Physical Demands This position is in a typical office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients. Some travel may be required. EOE M/F/D/V – WellDyne and HealthDyne are equal opportunity employer and prohibits discrimination of any kind. All employment decisions are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, veteran or disability status, or any other protected status under federal, state, or local law.