Customer Service Representative

Description:

The Customer Care Specialist handles incoming calls regarding questions about a members prescription benefit. These calls include but are not limited to what a members copay would be, if a medication is covered, faxing forms to doctors for authorization on a medication before it can be prescribed, etc. You could explain a Customer Care Specialist does not negotiate drug costs with pharmacies, we are not a pharmacy, and are not an insurance company, we answer questions based on their pharmacy coverage

Understand, apply, and communicate client-specific prescription benefit and pharmacy claim processing information to include things like:

formularies (list of covered medications), clinical programs to improve health and reduce costs, member out of pocket costs, appeal rights prior authorization/exception processes and much more

Educate members on how to best utilize their benefits

Troubleshoot pharmacy claims real-time to include verifying information the pharmacy submits, comparing the claim result to benefit rules, and entering allowed overrides to allow claims to pay

Send documents to providers electronically

Follow up and provide superior service through outbound calls as necessary

Anticipate and address questions to prevent repeat calls in order to delight customers and reduce customer effort

Treat all customers with respect and display empathy

Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements

Deliver all relevant information timely, clearly communicating in a manner that ensures customer understanding

Utilize resources consistently to incorporate changes in our fast-paced environment

Adapt to fluctuations in workload from slower times to extremely busy times

Effectively work/communicate with internal teams, such as other Customer Care team members, Prior Authorization, Manual Claims

Maintain scheduled hours and demonstrate flexibility to aid in coverage

Support the client mission statement in a professional manner

Skills:

Customer service, Computer Skills, insurance verification, inbound call, pharmacy benefit, pbm, prescription benefits, medical claims processing, prior authorization

Top Skills Details:

Customer service,Computer Skills,insurance verification

Additional Skills & Qualifications:

2+ years of prior medical Customer Service experience

1 year of work-from-home experience

Excellent phone etiquette and typing skills (40wpm, 500kph)

Basic knowledge of Microsoft Office and the Internet is required. Will be reviewing documents of pharmacy benefits.

Excellent oral and written communication skills

Ability to hear needs and translate them into correct resolution steps

Ability to navigate systems efficiently and effectively while speaking

Ability to balance quality with speed

Ability to identify the root cause of a problem from information presented

Ability to use resources to solve problems independently

Reliability including maintaining your schedule, consistently positive attitude and professional behavior at all times

100% remote opportunity

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.