In a few words…
As the Rx Customer Service Specialist, you will serve at the front line of all incoming and outgoing communication (calls, emails, and fax) with pharmacies, beneficiaries and prescribers. You will use Rx Platform and other resources as necessary to resolve callers’ needs. Furthermore, you’re the best at it because great customer service is definitely a skill you were born with.
The fundamentals for the job…
- You will manage all incoming calls, emails, faxes, and web-generated requests from pharmacies, beneficiaries and prescribers.
- All calls must be managed within the service-level standards set by CMS or by client; 80% of calls should fall within service level, less than 5% abandon rate and speed to answer should be less than 30 seconds. You got this from the get go.
- Rejection support, including overrides.
- Coverage Determination, exception and appeal status to clients.
- Administrative PAs- Document PA request inquiries, issues, status and resolution in accordance with federal and department / company policies and guidelines.
- Answer questions and recommend corrective services to address customer complaints, payment status, manual reversal requests, benefit/eligibility support, provider portal support and response to price appeals.
- Member card production, provider directories and conduct client satisfaction surveys.
- Seriously, no one holds a candle to you in this area.
The bold requirements…
- High School Diploma; Pharmacy Technician Associate’s Degree or Bachelor’s Degree, and Current/Active Certified Pharmacy Technician License; in addition, a minimum of 1 year working in a Pharmacy Call Center, OR 2 years working in a retail or hospital pharmacy setting, OR 3 years working in a non-pharmacy related customer service role (preferred). (In lieu of a degree, equivalent relevant work experience may be considered.)
- Knowledge of PBM clinical operations and Medicare Part D is preferred, big-time.
- Computer proficiency, knowledge of Microsoft Office products, and Internet experience, a must, of course.
- Superior interpersonal and customer service skills. This is your calling card, your distinctive feature, and your reputation probably precedes you.
- Previous experience in insurance, pharmacy, and / or healthcare preferred.
- You must be able to communicate effectively (read, write, speak, daydream, argue, text, etc.) in English and Spanish.
That something extra we´d love to see…
- Analytical: You value the power of context & enjoy examining the past. You get the present by analyzing (sometimes over-analyzing) events leading up to it. This methodology is super helpful, but can provoke analysis-fatigue in those within earshot. Good thing you’re aware of this.
- Detailed: Nothing gets by you and you rarely forget a thing. When learning some new procedure, you’re the type to take notes. When everyone else is still lost, you’re already at the next steps. Others count on this skill of yours.
- Respectful: You are fair and aware of the need to treat people the same by setting up clear rules and adhering to them. This has opened many doors to you at every level.
- Organized: You are strong in the Organization area, and you enjoy order. Disorder is like constant noise to you, and you can’t stand it.
- People Person: You enjoy the challenge of meeting new people and winning them over. You feel rewarded just from breaking the ice and making a connection with another. You would probably make a great diplomat.
The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is absolutely not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.