Customer Service Representative - Full-time / Part-time

Job description:

and Description:This company currently services 27 million members nationwide with clients that include Fortune 500 employer corporations, unions, managed care organizations, health plans, insurance carriers, third-party administrators, as well as local, state and federal employee programs. The company provides a comprehensive range of services to manage pharmacy benefits for a variety of health care providers across the United States. One of the primary services they provide is the processing of pharmacy claims and prior authorization requests. Once a member takes their prescription from their physician to their pharmacist to be filled, the pharmacist will electronically link into the company's claims system to verify coverage and the copay amount to charge the member. If the member, physician or pharmacist has any questions, special requests or issues with the prescription, they are directed to the Call Center which is where they will interact with the CSR's. The calls will vary depending on who is calling and from what state. If the call is coming from a member, the calls normally are concerning the prescription coverage they have and why they cannot obtain a specific prescription. If the call is from a physician or pharmacist, the calls become a bit more technical in nature as they are looking for specific member information, coverage boundaries, copay adjustments, and submitting prior authorization requests for members. The CSR will be required to handle all of these calls but, with time and proper performance, they could be moved to a specific caller queue. The CSR will be responsible for answering these inbound calls promptly and with outstanding professionalism as they will not know where the call is coming from before they begin the call. They will take the caller information first and verify account info before moving forward with the reason for the call. The CSR will then provide the caller with a solution accordingly and document all communication. At the end of every call the CSR is required to ask if there is anything else they can assist the caller with before disconnecting with the caller.