Posted 2 years ago

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

Job Features

FLSA statusExempt
Type of employmentFull Time
LocationCorporate Office
DepartmentCustomer Service
CompensationN/A

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