Member Services Representative

SUMMARY

TheMember Services Representative position is responsible for providing quality and efficientcustomer servicetomembers and employees through a member focused approach for CerpassRx.The Member Services Representative will assist and perform multiple duties within the Call Center with professional and dedicated service to our pharmacies, members, clients, and internal and external teams.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• To answer calls and stay abreast of call taking processes and procedures.
• Assist the team by addressing, questions, manage problem resolution related to pharmacy benefit, provider or claim issues
• Provide accurate and timely information to internal and external customers in a professional, responsive, and service oriented manner.
• Tracking and reporting for quality activities.
• Assist in operational processes and assists in problem solving strategies
• Performs job related functions using independent judgment, excellent reasoning ability, and excellent communication skills.
• Share knowledge and assist other team members on workflows and job requirements.
• Ability to maintain confidentiality and adhere to HIPAA requirements
• Flexible, uses critical thinking skills and open to learning new ideas/skills
• Other duties or special projects may be assigned as necessary

MINIMUM QUALIFICATIONS:

• Excellent communication skills and writing skills
• Strong quality knowledge with the ability to provide feedback, coaching and create documentation.
• Team player with a positive attitude- Member focused
• 2 or more years’ telephone Member Service experience in a related field
• Experience and knowledge of pharmacy terminology, process of prior authorizations and claim processing
• HS Diploma
• Pharmacy Tech certified preferred

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk and hear and to use hands to finger, handle, or feel. The employee frequently is required to sit. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.