Duration: July 2018-March 2019 (Temp to hire based on performance)
Training Hours: Monday through Friday from 8:00 AM to 4:30 PM
Hours: Monday through Sunday from 8:00 AM to 9:00 PM; 8-hour shift/40-hour week
-Processes coverage determination requests received by mail, fax, electronic portal or telephone.
-Works in various queues to ensure proper handling of all processes related to coverage determination requests.
-Works with time sensitive material and must adhere to mandates turnaround times on all work.
-Responds to inquiries from customers for information and assistance related to coverage determinations.
-Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
-Seeks assistance with complex customer services issues.
-Makes outbound notification calls to members and/or their appointed representatives regarding status of requests.
Working hours: 8:00 AM - 9:00 PM
-Position typically requires excellent interpersonal skills, ability to understand and interpret policy provisions.
-General knowledge of formulary process, and branded versus generic drugs required. -Excellent verbal and written communication skills.
-Excellent customer service/people skills.
-Excellent telephone and PC/data entry skills.
-Ability to handle high volume of calls.
-Ability to multi-task, i.e. data entry with speed and accuracy while managing calls.
-Ability to handle and resolve escalated issues.
-Strong decision making skills to appropriately serve the customer.
-Ability to interact within a diverse workplace.
-Must be able to sit for the majority of shift and be comfortable working in a call center environment.
-All work is subject to review and follow up for errors and coaching by management staff/agency.
-Experience within role, at least 1 year
-Experience with creating and processing prior authorization is a plus
-Experience making outbound calls a to verify information is a plus
-Experience answering inbound calls is a plus
-High School Diploma or GED required, some college/college degree preferred.
-1+ years of Call Center experience and retail pharmacy experience preferred.
-Pharmacy Technician Certification preferred
Please send resume to firstname.lastname@example.org
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