Servicing Representative

Independent Health Association•Buffalo, NY

1d•$19

About The Position

The Servicing Representative is a customer service professional who displays confidence, a passion for service, and practices empathetic listening towards all Pharmacy Benefit Dimensions (PBD) customers. The Servicing Representative functions as an advocate for all customers and resolves all inquiries (i.e., phone, mail, fax, and email.) They Servicing Rep utilizes 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 or GED required; Associate degree preferred
Six (6) months experience working for a health insurance company, physician’s office or pharmacy required.
Demonstrated ability to effectively communicate with internal and external customers.
Excellent written/verbal communication skills, excellent customer service skills.
Demonstrated ability to listen with intent to understand.
Demonstrated proficiency to verbally translate written communication.
Typing 35-40 words a minute required.
Demonstrated proficiency in problem solving and proven ability to prioritize accordingly.
PC and Windows experience with proficient typing skills and ability to utilize multiple system tools simultaneously.
Strong organizational/time management skills
Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Nice To Haves

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.

Responsibilities

Responsible for acting as a customer advocate by providing excellent customer service when answering customer 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.
Ensuring 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 the representative’s scorecard: Quality goals - measure Representative’s ability to consistently respond to customers with excellent customer service. Productivity goals - measure Representative’s ability to be productive and use time effectively and efficiently. Includes average talk plus hold time, after call work (ACW), adherence, use of non-available states, tardiness and attendance. Accuracy goals - measure Representative’s 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 and maintaining updates on a daily basis.
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 (Siebel, HealthRules, RxClaim, Macess, Reveal, E-mail and other systems as needed) 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.