Customer Service Representative

Job Description:

• • research required information using available resources
  • add new or extended existing authorizations for medications
  • process PA forms
  • identify and escalate priority issues (example: unable to adjudicate a med)
  • route calls to appropriate resource
  • follow up customer or prescriber calls when necessary
  • update existing clmakes outgoing calls to pharmacies to adjudicate authorized medications
  • aimant information when necessary
  • document all call information according to standard operating procedures
  • complete call logs

Job Duties & Essential Functions:

• Approved Rejects
• Chatter & Chat
• New/In Process IWO Claimant & Employer Calls
• After Hour Protocols
• Sending, Receiving & Viewing Emails 
• Documenting Calls, Calls Back, Call Log Documentation & History. 
• Claimant Search, Claimant Maintenance and Claim History
• Claimant/Claim Prescriber Panels
• Rollback History/Med History 
• Switch Calls/Reprice SW Contracted/Reprice SW Non-Contracted ​ FUTURE

Job Qualifications:

• Education
  • High school diploma or GED
  • 2 years minimum contact center experience
• Experience:
  • Proficient in relevant computer applications
  • Required language proficiency
  • Knowledge of customer service principles and practices
  • Knowledge of call center telephony and technology
  • Some experience in a call center or customer service environment
  • Good data entry and typing skills
  • Knowledge of administration and clerical processes
• Supervisory experience: N/A
• Other competencies or skills:
  • Oral Comprehension — The ability to listen to and understand information and ideas presented through spoken words and sentences.
  • Oral Expression — The ability to communicate information and ideas in speaking so others will understand.
  • Speech Clarity — The ability to speak clearly so others can understand you.
  • Speech Recognition — The ability to identify and understand the speech of another person.
  • Near Vision — The ability to see details at close range (within a few feet of the observer).
  • Problem Sensitivity — The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
  • Written Expression — The ability to communicate information and ideas in writing so others will understand.
  • Written Comprehension — The ability to read and understand information and ideas presented in writing.
  • Deductive Reasoning — The ability to apply general rules to specific problems to produce answers that make sense.
  • Inductive Reasoning — The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
  • Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
  • Interacting With Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
  • Communicating with Persons Outside Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other
  • external sources. This information can be exchanged in person, in writing, or by telephone or email.
  • Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, email, or in person.
  • Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time.
  • Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
  • Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job.
  • Processing Information — Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
  • Resolving Conflicts and Negotiating with Others — Handling complaints, settling
• Background Checks/Licensing Requirements: N/A