The role of the Customer Service Specialist is to build trusted relationships with our clients, their claimants and our vendor partners and their providers by providing superior customer service.
1. Works with Team Lead, Supervisor and Manager to resolve phone inquiries related to claims adjudication, eligibility verification, prior authorization and other Pharmacy Benefit Management, Ancillary Benefits Management and some Billing Verification Department functions as required. Utilizes strong verbal and written communication, listening and organizational skills as well as strong problem-solving and reasoning skills to accomplish this.
2. Demonstrates ability to adhere to attendance, punctuality, and quality guidelines including a flexibility to work varying or rotating shifts, including overtime, weekends, and holidays as necessary.
3. Demonstrates ability to read prescription drug names, comprehend simple instructions, and write short correspondence/memos as well as translate jargon and complex processes into simple, step-by-step instructions.
4. Demonstrates attention to detail, ability to work in an ever-changing work flow environment, patience, professionalism, and compassion while handling difficult customers and situations. Shows flexibility and a customized approach in meeting all types of member communication styles and personalities. Takes initiative and assumes responsibility where appropriate.
High school diploma or general education degree (GED) and one to two years related customer service and/or ABM experience required; or equivalent combination of education and experience.
Knowledge, Skills and Abilities:
Experience in health insurance industry or ABM is desired. Must be able to type a minimum of 35wpm and have the ability to multi-task moving from multiple screens on dual monitors. Knowledge of Windows based applications is necessary.
Physical Demands/Working Conditions:
Duties are performed primarily in an office setting. Travel to attend meetings and visit locations throughout the country may be required. Operate computer and standard office equipment such as telephone, copier, and printer. While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is frequently required to use hands. The employee is occasionally required to stand and walk.
*** Job descriptions will be reviewed and are subject to changes of business necessity. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.