Call Center Representative (Must Have 2+ Years Experience) + Read Job Description

TEKsystems•Northville Charter Township, MI

4d•$21 - $21•Onsite

About The Position

The Customer Service Representative (CSR) plays a key role in supporting members, providers, and other stakeholders by delivering high-quality service in a fast-paced environment. This role involves responding to inbound inquiries, researching member and provider information, and accurately documenting all interactions while maintaining strict confidentiality and compliance standards. The CSR will handle high-volume inbound calls from members, pharmacies, providers, and other partners, actively addressing questions related to prescription benefits, prior authorizations, eligibility, and general plan information. They will also conduct follow-up outbound calls as needed to provide updates, clarify information, or resolve outstanding issues, providing clear, empathetic, and professional communication, ensuring each caller receives an excellent customer experience. Responding to questions involving confidential or sensitive information, following HIPAA and internal compliance guidelines at all times, and accurately documenting all call details in multiple internal systems, ensuring complete and precise data entry are key aspects of this role. The CSR will navigate and utilize multiple software platforms simultaneously, including benefit tools, authorization systems, member databases, and communication logs, as well as meet and exceed performance metrics, including call quality, accuracy, productivity, customer satisfaction, and adherence to schedule. The role involves managing a daily workload of approximately 80-100 calls per day, depending on call complexity and case-by-case research requirements, troubleshooting issues related to prior authorization status, medication coverage, formulary questions, and pharmacy claim inquiries. Collaboration with internal departments to escalate or resolve complex cases when needed, demonstrating strong attention to detail, ensuring all information captured is complete, accurate, as well as compliant, is also expected.

Requirements

Must have call center experience in any industry.
Must be able to commit to a commute to Plymouth Monday-Sunday 5a-10pm (call center hours).
2+ Years Experience

Responsibilities

Handle high-volume inbound calls from members, pharmacies, providers, and other partners, actively addressing questions related to prescription benefits, prior authorizations, eligibility, and general plan information.
Conduct follow-up outbound calls as needed to provide updates, clarify information, or resolve outstanding issues, providing clear, empathetic, and professional communication, ensuring each caller receives an excellent customer experience.
Respond to questions involving confidential or sensitive information, following HIPAA and internal compliance guidelines at all times, accurately documenting all call details in multiple internal systems, ensuring complete and precise data entry.
Navigate and utilize multiple software platforms simultaneously, including benefit tools, authorization systems, member databases, and communication logs.
Meet and exceed performance metrics, including call quality, accuracy, productivity, customer satisfaction, and adherence to schedule.
Manage a daily workload of approximately 80-100 calls per day, depending on call complexity and case-by-case research requirements, troubleshooting issues related to prior authorization status, medication coverage, formulary questions, and pharmacy claim inquiries.
Collaborate with internal departments to escalate or resolve complex cases when needed, demonstrating strong attention to detail, ensuring all information captured is complete, accurate, as well as compliant.