XTN-FAE4172 | CUSTOMER SERVICE REPRESENTATIVE I

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.

• Health Insurance/HMO 
• Enjoy unlimited MadMax Coffee
• Diverse learning & growth opportunities
• Accessible Cloud HR platform (Sprout)
• Above standard leaves
• Quarerly incentive payouts based on performance

• 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.

• 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 communicate verbally and present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

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.