TEKsystems
Description
Care Managers conduct high‑volume outbound calls to payors/pharmacy benefit managers (PBMs) to determine whether commercially insured patients on supported products are eligible for copay support. This role is phone‑intensive (up to 95% of the shift on calls), requires disciplined use of approved call guides, precise documentation in our systems, and professional customer service on recorded lines. There is no patient or caregiver interaction in this role.
Essential Duties & Responsibilities
Make outbound PBM/payor calls for copay eligibility throughout the workday; maintain phone engagement up to 95% of the shift while executing the correct outbound campaigns and dispositions.
Follow approved Call Guides to ask structured, plan‑identifying questions of PBM agents; use compliant script and payor‑call steps.
Determine and record the verified plan type: Traditional, Accumulator, Hybrid Accumulator, Maximizer, or Hybrid Maximizer, etc., using program definitions and SOPs.
Use PBM‑specific prompts (e.g., BIN/PCN/Group workflows, NPI handling, maximizer screening questions) to obtain the benefit details needed for eligibility determination.
Document every interaction accurately and in real time: complete call‑guide fields, outcomes, and notes in the designated CRM/telephony tools before taking/making the next call.
Create and manage follow‑up activities/tasks as needed with timely completion.
Maintain availability/status discipline in the telephony platform (Available/Ready, appropriate Away Codes, correct outbound campaign selection) to maximize connect time.
Adhere to program compliance and quality standards (privacy, script adherence, recorded‑call protocols) and participate in QA monitoring.
Collaborate professionally with payor/PBM contacts and internal teams; route inquiries outside program scope through approved channels.
Customer Service & Conduct
Demonstrate courtesy, respect, empathy, and a service‑first mindset on every payor/PBM interaction.
Apply active listening and de‑escalation techniques with agents as needed.
Uphold workplace conduct guidelines and use only approved systems/channels for communications and documentation.
Qualifications
High‑volume outbound call center experience (PBM/payor calling preferred); comfort with phone‑based work for the majority of the shift.
Familiarity with pharmacy benefit verification and PBM processes; ability to identify and document the plan types listed above using call‑guide prompts.
Computer proficiency: CRM/telephony tools, accurate typing, structured note‑taking, and data entry.
Strong listening, questioning, and problem‑solving skills; ability to follow SOPs and elevate internally when payor information is incomplete or conflicting.
Professional verbal communication; consistent, courteous demeanor on recorded lines.
High School Diploma or equivalent (some college preferred).
Minimum 1–2 years in a high volume call center environment.
At least 1 year experience in insurance verification, pharmacy benefit investigation, or related healthcare services (medical billing, prior authorization support).
Preferred: Familiarity with PBM processes, copay assistance programs, and benefit plan types (Traditional, Accumulator, Maximizer).
Performance Metrics (Examples)
Phone time/adherence (targeting up to 95% outbound activity).
Call‑guide adherence and QA scores; correct plan‑type identification per program definitions.li>
Documentation completeness and timeliness; follow‑up task creation and completion rate.
Work Conditions & Schedule This is a remote phone‑based, payor/PBM‑facing role conducted on recorded lines. Copay Business hours are 8am to 8pm EST. Candidates may be assigned standard business hours with shift assignments; overtime or campaign support may be requested during peak periods.
Skills
Insurance verification
Prior authorization
Medical insurance
Customer service
Multi‑tasking
Call center
Additional Skills & Qualifications
Minimum 6 months to one year experience in medical billing, insurance verification, or similar related medical office experience.
Previous data entry experience (minimum three months) and ability to type 30 wpm or more.
High attention to detail.
Computer savvy, able to navigate multiple computer tabs, monitors and applications.
Advanced knowledge of Microsoft Suite programs (Teams, Word, Excel, Outlook, etc.) and soft phone systems (WebEx, Mitel, ShoreTel, etc.).
Exceptional written and verbal communication skills.
Ability to work in a virtual team environment by being available and responsive during working hours.
Excellent follow‑through.
Remote position; private workspace free of distractions to adhere to HIPAA compliance and guidelines. Workspace must include internet plug‑in accessibility. Wi‑fi connectivity is not permitted.
A working cell phone is required for two‑step authentication verifications during the assignment.
Experience Level Entry Level
Job Type & Location This is a Contract position based out of Orlando, FL.
Pay And Benefits The pay range for this position is $21.00 - $21.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision
Critical illness, accident, and hospital
401(k) retirement plan – pre‑tax and Roth post‑tax contributions available
Life insurance (voluntary life & AD&D for the employee and dependents)
Short‑ and long‑term disability
Health spending account (HSA)
Transportation benefits
Employee assistance program
Time off/leave (PTO, vacation or sick leave)
About the Company TEKsystems is a leading provider of business and technology services. We accelerate business transformation for our clients, with expertise in strategy, design, execution and operations. We work with progressive leaders to drive change and deliver business value.
The company is an equal‑opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Application Deadline Position anticipated to close on Jan 23, 2026.
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Essential Duties & Responsibilities
Make outbound PBM/payor calls for copay eligibility throughout the workday; maintain phone engagement up to 95% of the shift while executing the correct outbound campaigns and dispositions.
Follow approved Call Guides to ask structured, plan‑identifying questions of PBM agents; use compliant script and payor‑call steps.
Determine and record the verified plan type: Traditional, Accumulator, Hybrid Accumulator, Maximizer, or Hybrid Maximizer, etc., using program definitions and SOPs.
Use PBM‑specific prompts (e.g., BIN/PCN/Group workflows, NPI handling, maximizer screening questions) to obtain the benefit details needed for eligibility determination.
Document every interaction accurately and in real time: complete call‑guide fields, outcomes, and notes in the designated CRM/telephony tools before taking/making the next call.
Create and manage follow‑up activities/tasks as needed with timely completion.
Maintain availability/status discipline in the telephony platform (Available/Ready, appropriate Away Codes, correct outbound campaign selection) to maximize connect time.
Adhere to program compliance and quality standards (privacy, script adherence, recorded‑call protocols) and participate in QA monitoring.
Collaborate professionally with payor/PBM contacts and internal teams; route inquiries outside program scope through approved channels.
Customer Service & Conduct
Demonstrate courtesy, respect, empathy, and a service‑first mindset on every payor/PBM interaction.
Apply active listening and de‑escalation techniques with agents as needed.
Uphold workplace conduct guidelines and use only approved systems/channels for communications and documentation.
Qualifications
High‑volume outbound call center experience (PBM/payor calling preferred); comfort with phone‑based work for the majority of the shift.
Familiarity with pharmacy benefit verification and PBM processes; ability to identify and document the plan types listed above using call‑guide prompts.
Computer proficiency: CRM/telephony tools, accurate typing, structured note‑taking, and data entry.
Strong listening, questioning, and problem‑solving skills; ability to follow SOPs and elevate internally when payor information is incomplete or conflicting.
Professional verbal communication; consistent, courteous demeanor on recorded lines.
High School Diploma or equivalent (some college preferred).
Minimum 1–2 years in a high volume call center environment.
At least 1 year experience in insurance verification, pharmacy benefit investigation, or related healthcare services (medical billing, prior authorization support).
Preferred: Familiarity with PBM processes, copay assistance programs, and benefit plan types (Traditional, Accumulator, Maximizer).
Performance Metrics (Examples)
Phone time/adherence (targeting up to 95% outbound activity).
Call‑guide adherence and QA scores; correct plan‑type identification per program definitions.li>
Documentation completeness and timeliness; follow‑up task creation and completion rate.
Work Conditions & Schedule This is a remote phone‑based, payor/PBM‑facing role conducted on recorded lines. Copay Business hours are 8am to 8pm EST. Candidates may be assigned standard business hours with shift assignments; overtime or campaign support may be requested during peak periods.
Skills
Insurance verification
Prior authorization
Medical insurance
Customer service
Multi‑tasking
Call center
Additional Skills & Qualifications
Minimum 6 months to one year experience in medical billing, insurance verification, or similar related medical office experience.
Previous data entry experience (minimum three months) and ability to type 30 wpm or more.
High attention to detail.
Computer savvy, able to navigate multiple computer tabs, monitors and applications.
Advanced knowledge of Microsoft Suite programs (Teams, Word, Excel, Outlook, etc.) and soft phone systems (WebEx, Mitel, ShoreTel, etc.).
Exceptional written and verbal communication skills.
Ability to work in a virtual team environment by being available and responsive during working hours.
Excellent follow‑through.
Remote position; private workspace free of distractions to adhere to HIPAA compliance and guidelines. Workspace must include internet plug‑in accessibility. Wi‑fi connectivity is not permitted.
A working cell phone is required for two‑step authentication verifications during the assignment.
Experience Level Entry Level
Job Type & Location This is a Contract position based out of Orlando, FL.
Pay And Benefits The pay range for this position is $21.00 - $21.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision
Critical illness, accident, and hospital
401(k) retirement plan – pre‑tax and Roth post‑tax contributions available
Life insurance (voluntary life & AD&D for the employee and dependents)
Short‑ and long‑term disability
Health spending account (HSA)
Transportation benefits
Employee assistance program
Time off/leave (PTO, vacation or sick leave)
About the Company TEKsystems is a leading provider of business and technology services. We accelerate business transformation for our clients, with expertise in strategy, design, execution and operations. We work with progressive leaders to drive change and deliver business value.
The company is an equal‑opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Application Deadline Position anticipated to close on Jan 23, 2026.
#J-18808-Ljbffr