Call Center Representative 2

Summary:

This position will be in support of inbound calls and resolve member issues related to RX, PCP, Benefits, and Eligibility.

Job Duties:

• Resolve incoming calls regarding member eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needs
• Compose routine and non-routine correspondence to answer benefits/provider inquiries in writing
• Coordinate membership changes, such as member's primary care physician
• Perform routine to mid-level inventory reduction, including member inquiries, claim adjustments, and email responses
• Review and analyze member claims for accuracy and provide member education on how benefits are applied
• Participate in quality and efficiency workgroups to improve member/customer satisfaction
• Analyze available programs, determine program eligibility, and connect members to appropriate vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists
• Verify member inclusion or targeting in outreach or care gap programs and connect members to programs or services when appropriate
• Engage members with their wellness plan options
• Resolve pharmacy calls regarding benefits coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements
• Provide prescription-related benefit coverage information, including co-pays, formulary coverage, and utilization management requirements
• Provide deductible and max out of pocket information
• Provide status of prior authorization requests
• Assist members in understanding when and how to appeal a coverage decision
• Perform other assigned duties

Skills/Qualifications:

• Requires at least 2 years of prior relevant experience (e.g. Customer Service), preferably Healthcare Experience
• Requires basic job knowledge of Microsoft Suite systems and proficiency in computer applications
• Background in Armed forces preferred
• Call Center Experience preferred

Education Requirements:

Minimum High School Diploma

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one’s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one’s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.

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