Provider Relations Representative

Representative

Remote

August 11, 2026

Application ends: November 8, 2026

REQUIREMENTS

Knowledge, Skills, and Abilities:

Excellent verbal and written communication skills
Good interpersonal skills: able to work and communicate effectively with all levels of co-workers, clients, and other external contacts
Strong organizational and time management skills
Dependable with good attendance and adherence to timelines and schedules
Strong analytical skills
Good problem-solving skills
Consistent follow-through on issue resolution
Resourceful, with the ability to take initiative in development and completion of projects
Strong sense of customer service
Basic computer knowledge through effective use of a personal computer including Microsoft Office applications, specifically: file management skills, Internet, Microsoft Windows, database, word processing (Word), spreadsheets (Excel), presentation software (PowerPoint), graphics
Knowledge of and experience in the pharmacy and healthcare industry regarding terminology and retail pharmacy operations, including understanding of how and why pharmacy claims process (e.g., calculation of copayments, pricing hierarchies)
Basic drug knowledge and understanding of Therapeutic Categories (TC), Multi-Source Indicators (MSI), Generic Product Identifier (GPI), Generic Code Number (GCN), Drug/claim statuses: Paid vs. Captured; PDL/NPDL; “F” – Formulary (paid) vs. “G” – Non-formulary paid

RESPONSIBILITES

Serve as the front-line contact for our client’s pharmacy members requesting information on, assistance with, or explanation of claims processing issues, our client’s PSAO contracts, pharmacy not-contracted, direct contracting, claims pricing, claims reconciliation, and missing data, etc. (requests received via pharmacy member service calls, emails, or faxes).
Maintain knowledge of our client’s existing and newly launched programs and services, including mastering content of our client’s programs and services guides for the purpose of servicing pharmacy members.
Conduct data pulls to validate contract information.
Follow up on eRecon and Central Pay issues for pharmacy members.
Follow defined work plans and leadership direction to meet due dates when addressing pharmacy member concerns or adverse issues.
Abide by department workflow, policies, and procedures.
Remain current on pharmacy industry trends and aware of our client’s pharmacy member business needs and concerns.
Monitor and address issues from Customer Support email box.
Document call and work activity in the Pharmacy Data Management System (PDMS) and review Daily Notes report to ensure follow-up and resolution.
Attend and actively participate in Provider Relations team meetings.
Provide support to other team members, as needed.