- 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
- High school diploma or GED
- 2 years minimum contact center 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
|Type of employment||Full Time|