Customer Service Representative

Customer Service Representative

Location: Cebu Exchange Tower | Onsite

Start Date: September 22, 2025

Job Description:

The Customer Support Representative I provides exceptional customer service to pharmacies, physicians, health plan sponsors, and their members, beneficiaries, or employees. It involves promptly responding to and effectively resolving phone inquiries concerning benefit information, claims adjudication, eligibility verification, prior authorization, and other pharmacy benefit management (PBM) processes. The position operates under general supervision, following instructions, work process guidelines, policies & procedures, and leveraging company knowledge/experience to fulfill job duties. Supervision levels vary from close to moderate depending on demonstrated skill and performance levels outlined for the role. Additionally, this position is part of a two-level career path with progression opportunities detailed in the Core Service Career Path/Succession Planning Guidelines.

Job Responsibilities:

• 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, , 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.

Qualifications:

• At least 1 year of call-handling experience in a BPO setting
• Willing to work the night shift (11 PM - 8 AM)
• Healthcare account experience is a plus (but not required)
• Open to applicants with experience in any BPO account