The posting
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.
- Health Insurance/HMO
- Enjoy unlimited MadMax Coffee
- Diverse learning & growth opportunities
- Accessible Cloud HR platform (Sprout)
- Above standard leaves
- 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.
Other Skills and Abilities
Demonstrated ability to appear for work on time, follow directions from a supervisor, interact well with coworkers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment. Demonstrated ability to meet or exceed the competencies as listed.
Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to interpret bar graphs.
Language Skills: Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Competencies:
To perform the job successfully, an individual should demonstrate the following competencies:
Customer and Quality Focus - Actively demonstrates a personal concern for understanding client needs, ensuring the quality of products and services, maintains a high level of customer satisfaction, and contributes to continuous improvement of products and processes.
Interpersonal Effectiveness - Demonstrates good people skills by showing a commitment to teamwork, resolving conflicts effectively and with respect for others’ viewpoints, respecting differences and building strong relationships and networks.
Communication -Expresses self clearly and effectively in face-to-face interactions, presentations and written documents, and employs active listening skills to ensure productive interactions.
Business Knowledge - Demonstrates clear understanding of the nature of the business -- its products and services, goals, market, competitors and challenges.
Teamwork - Functions as a valuable team member by engaging in collaborative decision making and problem solving, constantly contributes positively as a team member, shares credit when appropriate and encourages teammates to use their knowledge and skills. Reliability - Maintains good record of attendance and punctuality, conscientiously follows through on actions without excessive need for supervision, fulfills commitments.
Professionalism - Acts with integrity, shows self to be reliable and responsible, displays emotional intelligence, and conscientiously complies with all relevant laws, policies, and procedures. Quality Focus - Demonstrates a personal investment in ensuring the quality of products and/or services, going the extra mile to meet or exceed standards. Problem Solving - Analyzes problems logically to identify root causes, seeks input from a wide range of sources, asks insightful questions and formulates effective solutions.
Organization - Effectively organizes objects, resources, information, and workspace to ensure maximally efficient and effective work process. Initiative - Proactively gathers and analyzes information, assesses situations and identifies challenges and opportunities, sees what needs to be done and takes appropriate action.
Adaptability - Adjusts quickly to evolving situations by integrating new information, remaining flexible, recognizing and implementing necessary changes and taking advantage of opportunities presented by new developments.
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 sit and talk or hear. The employee is frequently required to use hands to finger, handle, or feel and reach with hands and arms. The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Working Environment: The work environment characteristics described here are representative of those an employee encounters while performing 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 in an office setting and is exposed to moderate noise (examples: business office with computers and printers, light traffic).
Working Hours: This is a non-exempt position requiring one to be able to work overtime from time to time in order to get the job done. Therefore one must have the ability to work nights, weekends and/or on holidays as required. This may be changed at any time to meet the needs
