Answer telephone inquiries in a pleasant, professional and efficient manner assuring exceptional customer service
Document all incoming calls and dialogue in the claims adjudication software
Educate clients on plan policies, benefits and procedures
Resolve client drug benefit concerns of a medical, financial, or technological nature
Initiate and facilitate prior authorization requests
Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines
Participate in on-call rotation
Accept other duties as assigned; including but not limited to: direct member reimbursement, processing, manual claims, reporting and researching rejected claims
Attend department and company meetings and educational programs upon request
Ensures that HIPAA guidelines are followed in every communication with clients
Interest in learning new tasks for development purposes
Embody AnewHealth’s Core Values in all communications and interactions
Requirements
Associate’s degree preferred
High School Diploma or equivalent required
CPhT (Certified Pharmacy Technician) certification, a plus
1 year of customer service/member service experience in a call center or similar, required
Health care industry experience, a plus
Experience in a pharmacy support role, a plus
Knowledge of plan and benefit structures and Medicare guidelines, a plus
Knowledge of pharmacology and pharmacological terms
Excellent communication skills and professionalism when working with clients
Ability to solve problems under pressure by making immediate decisions while on the phone
Detail oriented and able to prioritize workload
Strong computer skills including using word processors, spreadsheets, and database software