Customer Service Rep II, Medicare
Experience with Pharmacy or PBM, MCO highly preferred.
Training: M-F 8:00-4:30 cst, Post Training: Schedule 8 hours: M-F 7:00A-8:00P CST
Description:
In this role, you will be responsible for:
- Training and working virtually
- Utilizing multiple software systems to complete Medicare appeals case reviews
- Meeting or exceeding government mandated timelines
- Complying with turnaround time, productivity and quality standards
- Conveying resolution to beneficiary or provider via direct communication and professional correspondence
- Acquiring and maintaining basic knowledge of relevant and changing Med D guidance
Required Qualifications:
- Working independently but be self-aware enough to know when to ask for help
- Be technically capable to understand trouble-shooting steps and be able to communicate the results to leaders or IT
- Ability to effectively communicate verbally with members and prescribers while managing multiple software systems
- Accountable and results driven
- Critical thinker/problem solver
- Receptive to constructive feedback and flexible in adapting to change
- Ability to effectively plan, prioritize, and organize time and workload
- Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment
- Proficient in navigation of multiple computer applications
- Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors
- Ability to type more than 30 WPM
Job Duties:
- Training and working virtually
- Utilizing multiple software systems to complete Medicare appeals case reviews
- Meeting or exceeding government mandated timelines
- Complying with turnaround time, productivity and quality standards
- Conveying resolution to beneficiary or provider via direct communication and professional correspondence
- Acquiring and maintaining basic knowledge of relevant and changing Med D guidance
Required Qualifications:
-At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service
- 1 year in a call center or high volume phone intake environment.
- Six months of working in a virtual role where the supervisor is not physically in the same space
-Six months of PBM/pharmaceutical related work or Health Insurance experience.
-Six months of experience with Prior authorization, medications.
Preferred Qualifications:
-Working independently but be self-aware enough to know when to ask for help
-Be technically capable to understand trouble-shooting steps and be able to communicate the results to leaders or IT
-Ability to effectively communicate verbally with members and prescribers while managing multiple software systems
-Accountable and results driven
-Critical thinker/problem solver
-Receptive to constructive feedback and flexible in adapting to change
-Ability to effectively plan, prioritize, and organize time and workload
-Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment
- Proficient in navigation of multiple computer applications
-Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors
- Ability to type more than 30 WPM
-Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing. Ability to work in a fast paced environment, handling both inbound and outbound calls. Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines. Good communication skills are essential, both internal and external. Knowledge of Medicare benefits, enrollments and LIS assistance. Plans and organizes work assignments, set priorities and completes work with a minimum of supervision. Adheres to the service policy and principles of the company, as well as the program guidelines set by the department. Participates in cross-training to perform all roles within the department. Communicates effectively and professionally with our program partners to assure the best possible service for our patients and partners.
Education:
High School Diploma or GED required.
Job Type: Temporary
Pay: $17.00 - $18.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Flexible schedule
- Health insurance
- Paid time off
- Vision insurance
Experience level:
Shift:
Weekly day range:
Work setting:
Education:
- High school or equivalent (Required)
Experience:
- Call center: 1 year (Required)
- Customer service: 1 year (Required)
- health insurance: 1 year (Required)
- Prior Authorization: 1 year (Required)
Work Location: Remote