Job Title: Senior Customer Service Rep
Contract: 02/04/2019 to 06/28/2019
Training is 3 weeks from 8am-5pm, after training shift Start/End Time: Start times between 8:00am - 10:00am / End Times between 5:00pm - 7:00pm
Pay Rate: $14.00/hr
This is the primary service-level position in a business to business multimedia PBM contact center. The Member Services Rep serves as an initial point of contact to clients, nurses, pharmacies and physicians for inbound and outbound calls, faxes, e-mails, files and orders. The MSR also handles multimedia contacts from nurses authorizing payment for medications for hospice patients which must be entered into a web-based database within required turnaround times. Accuracy and knowledge of various operating procedures for different customers is a must.
Working hours: 8:00 AM - 5:00 PM
- Serve as initial point of contact to all incoming patient profiling, medication updates by pharmacies, nurses and other healthcare provider.
- Utilize multi-media functions (phone calls, faxes, and e-mail and integration files) to accurately input patient profile eligibility, medical history, clinical data, and updates into company operation platforms.
- Assist pharmacies in claims processing by providing information needed to process claims and researches all information related to pharmacy rejections.
- Process medication overrides for dosage changes or RTS (refills too soon), etc.
- Input manual claim data into the database on claims outside of processing window.
- Input appropriate claim processing call tracking notes with each call received.
- Provide patient medication profiles to facility pharmacies.
- Troubleshoot and resolve pharmacy related issues for Client Services.
- Input appropriate call-tracking notes with each call, fax, e-mail, or integration received.
- Assign coverage, transfers patients, or trouble shoots rejections as directed by clinical pharmacists.
- Implement new clients into the system for startup and quality check for accuracy and completeness.
- Accurately complete special projects assigned by management.
- Exhibit compliant and ethical behavior in the performance of job responsibilities, including complying with all applicable federal and state laws and regulations, company Code of Conduct, Business Ethics Policies and Procedures and other policies and procedures applicable to position.
- Actively participate in United Healthcare's Compliance and Ethics Program, including attending annual compliance and ethics training and reporting suspected violations of the law or Catamaran's policies and procedures.
- Knowledge of proper telephone etiquette; previous call center experience preferred.
- Must have attention to detail with excellent problem solving and multi-tasking skills
- Computer literacy / data entry skills are required and proficiency in Microsoft Word, Outlook, and Excel
- Excellent written and verbal communication skills are required.
- Experience with image display software and web-based data entry software.
- Knowledge of Medical Terminology and ICD-10 Codes preferred.
- Knowledge of drug therapies. (Generic/Brand names, drug classes, sigs)
- Basic math and analytical skills.
- Possess a positive attitude and great work ethic.
- Ability to work in a team environment and promote teamwork.
- Need to be able to work a flexible schedule including nights and weekends.
- Previous pharmacy technician experience highly desired, certification or licensure highly desired and/or related PBM business experience with knowledge of long term care pharmacy billing.
- Must have a High School diploma or equivalent. College or technical training a plus.
Please apply online. After applying online you may email resumes to email@example.com with "CSR-Montgomery" in the subject line
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