Customer Service Representative
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Provides outstanding customer service to pharmacies, physicians, health plan sponsors, and their members, beneficiaries, or employees by responding to and resolving phone inquiries related to benefit information, claims adjudication, eligibility verification, prior authorization, and other PBM processes.
Works under general supervision, relying upon instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform the functions of the job. Extent of supervision ranges from close to moderate based upon demonstrated skill and performance levels as defined for the position. This position is part of a two level career path with progression opportunities described in the Core Service Career Path/Succession Planning Guidelines.
The main responsibilities of a CUSTOMER SERVICE REPRESENTATIVE I include:
- Convey a positive image of the company by promptly responding to customer phone inquiries and determining the appropriate actions to resolve issues, gather and provide information, and offer assistance.
- Deliver service that meets or exceeds department performance standards for Average Hold Time, Abandonment Rate, Talk Time, Quality, Adherence, and One-touch Resolution.
- Utilize multiple company database programs to research and resolve complex issues relating to benefit information, claims adjudication, eligibility verification, prior authorization, and other PBM processes. Use task route function, SalesForce.com, and other processes & tools as applicable to escalate issues, request follow up action, or obtain assistance from other areas of the organization as necessary.
- Educate external customers about MedImpact’s roles and responsibilities. Provide information about override guidelines, benefit plan restrictions, prior authorization requirements, grievance and appeal processes, and other PBM functions as specified by health plan sponsors in online CS Notes.
- Follow up with callers as appropriate to ensure customer satisfaction and timely response to requests. Diffuse irate or emotionally upset customers by appropriately listening to issues, calming the customer, and providing positive solutions to resolve concerns.
- Represent MedImpact in a positive manner by adhering to SMART processes and established procedures and guidelines. Support the department strategy by delivering Customer Service
- Excellence through telephone courtesy, prompt response to callers, anticipation of customer needs and concerns, solution-oriented problem solving, and adherence to call center scripts, greetings, and call closing messages.
- Identify opportunities and make recommendations to department leadership for improvement of workflow processes, operating systems, training programs, reference materials, and quality initiatives that enhance the customer experience.
- Keep current on new plan information and instructions by attending and participating in staff meetings, RTL’s, company-required training programs, and other activities that develop skills, build teamwork, and provide updated information.
- Pharmacy Technician Certified CSR’s support physician calls and can review Prior Authorization (PA) guidelines noted in the MedAccess system.
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