Servicing Representative

Reliance Rx Specialty Pharmacy

3d•$19

About The Position

The Servicing Representative is a customer service professional who will display confidence, a passion for service, and practice empathetic listening towards all Pharmacy Benefit Dimensions (PBD) customers. The Servicing Representative will function as an advocate for all customers and resolve all inquiries (i.e., phone, mail, fax, and email). They will utilize system tools and resources to address and resolve inquiries; provide benefit clarification and eligibility; communicate claim and reimbursement information, facilitate proper utilization of policies and procedures, coordinate resolution to streamline processes; make demographic changes; and educate customers on regulatory policies and procedures.

Requirements

High school diploma or GED required.
Six (6) months of experience working for a health insurance company, physician’s office or pharmacy required.
Ability to effectively communicate with internal and external customers.
Excellent written and verbal communication skills, excellent customer service skills.
Typing 35-40 words per minute is required.
Proficient in problem solving with the ability to prioritize accordingly.
Ability to utilize multiple system tools simultaneously.
Strong organizational and time management skills.
Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Nice To Haves

Associates degree preferred.
Experience handling self-funded pharmacy calls preferred.
Experience in a call center operations environment preferred.
Experience handling high volume, inbound and outbound phone calls preferred.
Ability to listen with intent to understand.
Proficient in verbally translating written communication.

Responsibilities

Act as a customer advocate by providing excellent customer service when answering phone calls, written correspondence and servicing walk-in members in a timely fashion.
De-escalate customers as needed and resolve customer complaints.
Ensure that our customers are obtaining accurate and up-to-date information on policies and procedures and communicate a successful resolution to inquiries.
Ensure compliance with all CMS rules and regulations.
Log all contacts into appropriate systems.
Meet or exceed all department standards in the following categories as measured and recorded by the representative’s scorecard: Quality goals - measure ability to consistently respond to customers with excellent customer service. Productivity goals - measure ability to be productive and use time effectively and efficiently to include average talk plus hold time, after call work (ACW), adherence, use of non-available states, tardiness and attendance. Accuracy goals - measure ability to respond to inquiries correctly and accurately.
Maintain technical knowledge regarding Pharmacy Benefit Dimensions’ contracts and benefits and working knowledge of policies and procedures while maintaining updates daily.
Attend required training sessions as needed.
Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards (NCQA, State, CMS etc.), addressing first-level complaints and providing assistance on appeals as needed; receive and effectively resolve written inquiries from members regarding claims, benefits, eligibility, reimbursement and participating providers.
Knowledge of all systems and training manuals and the ability to coordinate the use of these tools at the same time.
Other duties as required by immediate supervisor which may include servicing walk-in members, correspondence support and making outbound phone calls.