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PBM Customer Service Representative

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Date: Mar 22, 2019

Location: Milwaukee, WI, US

Company: NTT DATA Services

Req ID: 42742 


At NTT DATA Services, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company’s growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA Services and for the people who work here.


NTT DATA Services currently seeks a PBM Customer Service Representative to join our team in Milwaukee, Wisconsin (US-WI), United States (US).



NTT DATA has the opportunity to help find and place a Customer Service Representative for a temp to hire position with one of our client's. The selected candidate will work LOCALLY on site at client's location in Milwaukee, WI.



Position Summary

The Customer Service Representative works in a call center environment and responds to member and client requests/inquiries regarding prescription drug plan coverage or ordering prescriptions through the mail order pharmacy. Assists pharmacies to properly adjudicate electronic prescription drug claims and resolve adjudication error messages. Serves as a liaison between members, pharmacy, clinical, benefit administrators (i.e. clients, TPA’s, etc.), and various internal functional areas.


Basic Qualifications:

  1. Provide prompt, accurate responses to caller’s inquiries regarding prescription drug benefit plan information and plan limits to members and providers within service level performance metrics established by the Company.
  2. Assists in answering inbound calls related to placing refill prescription orders and processing questions regarding the mail order pharmacy operation.
  3. Accurately enter standard and Clinical Prior Authorizations through the Customer Service inbox as well as from Clinical or Client Services.
  4. Process manual eligibility requests for new enrollments, termination, member status changes and COBRA updates.
  5. Produce and mail membership ID cards within specified time and quality parameters based on the previous days eligibility and ad hoc client requests.
  6. Establish members with the mail order pharmacy including transfer of prescriptions.
  7. Respond to customer email inquiries.
  8. Provide basic troubleshooting and support for members using the Company's PBM and mail order applications and automated prescription phone service.
  9. Process form letters to members and providers regarding benefit limitations, denial letters, etc.
  10. Manages all queues and email inboxes to ensure members are responded to in a timely manner.
  11. Timely and accurate updates of associated reports, logs and materials.


Preferred Education and Experience

  • High School diploma or GED.
  • One year of customer service experience in a call center environment.
  • Knowledgeable in employee health insurance benefits; experience with pharmacy/prescription drugs.


Preferred Qualifications:

  • Requires excellent communication skills (written and verbal).
  • Demonstrated ability to work effectively with Members, staff, and prescribers or customers.
  • Ability to switch between multiple screens/software programs quickly and efficiently to resolve customer concerns while on the telephone.
  • Basic computer skills and experience with Microsoft Word and Excel.
  • Detail oriented, organized and have a sense of urgency to meet service level performance objectives in a fast paced environment.


Preferred Credentials / Licensing / Certification

  • Pharmacy Technician Certification Preferred


Physical Demands

  • Sitting for extended time periods (between 8-10 hours/day).
  • Operate typical office equipment such as a computer, telephone, copy machine, etc.


This position is only available to those interested in direct staff employment opportunities with NTT DATA, Inc. or its subsidiaries.  Please note, 1099 or corp-2-corp contractors or the equivalent will NOT be considered. We offer a full comprehensive benefits package that starts from your first day of employment.                                                                                


About NTT DATA Services


NTT DATA Services partners with clients to navigate and simplify the modern complexities of business and technology, delivering the insights, solutions and outcomes that matter most. We deliver tangible business results by combining deep industry expertise with applied innovations in digital, cloud and automation across a comprehensive portfolio of consulting, applications, infrastructure and business process services.


NTT DATA Services, headquartered in Plano, Texas, is a division of NTT DATA Corporation, a top 10 global business and IT services provider with 118,000+ professionals in more than 50 countries, and NTT Group, a partner to 88 percent of the Fortune 100. Visit to learn more.


NTT DATA, Inc. (the “Company”) is an equal opportunity employer and makes employment decisions on the basis of merit and business needs.  The Company will consider all qualified applicants for employment without regard to race, color, religious creed, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other class protected by law.  To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship to the Company would result.




Nearest Major Market: Milwaukee

Job Segment: Consulting, Cloud, Technology