- Research and analyze electronic and manual claims. Apply troubleshooting skills to resolve issues as allowed by the individual benefit
- Communicate prior authorization, exception, and appeals information to callers including required information, turn-around-times, and other applicable details
- Act as a pharmacy help desk specialist to aid pharmacies in submitting claims to include participation status, accurate processing codes, reject resolution/ assistance, formulary product information, and clinical program information
- Inform members how to use their benefit including information regarding participating pharmacies, best utilization of their benefit, formulary explanations, patient pay amounts, benefit restrictions, and other information as applicable
- Educate customers so they can better assist themselves to include available website/ portal functions. This includes anticipating and addressing questions which may drive repeat calls
- A high school degree or equivalent.
- Post high school education desired such as L.P.N. or Certified Pharmacy Technician
- Previous customer service experience required
- Previous data entry experience preferred
- Bilingual skills (Spanish speaking) are highly desirable
- Experience in a PBM or managed care call center desired. Experience in a mail or retail pharmacy setting desired
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
- Hours/Location: Monday - Friday 24/7, Remote
- Paid Volunteer Hours
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program - up to $750
- Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Eight paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program
-
Customer Care Representative
2 weeks ago
TEKsystems Appleton, United StatesJob Description · Job DescriptionDescription: · We are looking for an individual who will create a positive first impression and establish strong member relationships while assisting members and potential members with their telephone requests in a very fast paced environment. Maj ...
-
Banking Customer Care Representative
1 day ago
Teksystems Appleton, United StatesJob Description:We are looking for an individual who will create a positive first impression and establish strong member relationships while assisting members and potential members with their telephone requests in a very fast paced environment.Answering inbound calls in a courteo ...
-
Banking Customer Care Representative
6 days ago
TEKsystems Appleton, United StatesJob Description · Job DescriptionJob Description: · We are looking for an individual who will create a positive first impression and establish strong member relationships while assisting members and potential members with their telephone requests in a very fast paced environment. ...
-
Banking Customer Care Representative
2 weeks ago
TEKsystems Appleton, United StatesJob Description: We are looking for an individual who will create a positive first impression and establish strong member relationships while assisting members and potential members with their telephone requests in a very fast paced environment. Answering inbound calls in a court ...
-
Customer Care Representative
2 weeks ago
Jewelers Mutual Group Neenah, United States** Customer Care Representative (Hybrid Schedule)** · **Job Category****:** Customer Care **Requisition Number****:** CUSTO001595 Showing 1 location **Job Details** · **Description** · Jewelers Mutual, the nation's only company exclusively insuring the jewelry industry is hiri ...
-
Manager, Customer Care
2 days ago
Jewelers Mutual Group Neenah, United States** Manager, Customer Care** · **Job Category****:** Customer Care **Requisition Number****:** MANAG001552 Showing 1 location **Job Details** · **Description** · Jewelers Mutual, the nation's only company exclusively insuring the jewelry industry is hiring for a **Manager of Cu ...
-
French Bilingual Customer Care Rep
3 weeks ago
Alta Resources Neenah, United StatesAlta Resources is Hiring · Alta Resources is hiring French Bilingual Customer Service Representatives, located at our downtown Neenah call center, to support our client's products. You bring the desire to succeed as customer service professional and we'll provide the necessary tr ...
-
Customer Care Policy Specialist I
2 weeks ago
Jewelers Mutual Group Neenah, United States** Customer Care Policy Specialist I (entry level)** · **Job Category****:** Customer Care **Requisition Number****:** CUSTO001573 Showing 1 location **Job Details** · **Description** · Jewelers Mutual, the nation's only company exclusively insuring the jewelry industry is hir ...
-
Customer Care Specialist
2 days ago
ManhattanLife De Pere, United StatesWho we are: · ManhattanLife Insurance and Annuity Company was founded in 1850, the Company's longevity makes it one of the oldest and most reliable health and life insurance companies in the country. Operating successfully for 174 years is a testimony to ManhattanLife's endurin ...
-
Application Consultant
3 weeks ago
Nexus Dynamics Appleton City, United StatesAbout the Company · We are a medium-sized software manufacturer with approximately 50 employees located in Appleton City. · Our software solution helps our clients to centralize all product information such as images, texts, documents, and other media in one place. This allows fo ...
-
Seller of bakery goods
3 weeks ago
Skyline Solutions Appleton, United StatesLocation: 19057 Schwerin, Am Magaretenhof 8 | Contract type: Part-time, hours per week, permanent | Job ID: 840149 · What you'll be doing with us: · Who doesn't love the tempting smell of freshly baked goods? In our bakery, our customers can find everything their heart desires, f ...
-
Spanish Bilingual Customer Care Rep
2 weeks ago
Alta Resources Neenah, United StatesAlta Resources is Hiring · Alta Resources is hiring Spanish Bilingual Customer Service Representatives, located at our downtown Neenah call center, to support our client's products. You bring the desire to succeed as customer service professional and we'll provide the necessary ...
-
Integrative Customer Care Specialist
1 day ago
Nature's Way Green Bay, United StatesIntegrative Customer Care Specialist · Welcome to a better way, an authentic way. Welcome to Nature's Way. · Inside our minds, inside our hearts, inside our business, inside our bottles. · Our reason for being, the purpose that inspires our work every day, is quite simple: Help p ...
-
Integrative Customer Care Specialist
2 days ago
Nature's Way Green Bay, United StatesJob Description · Job DescriptionIntegrative Customer Care Specialist · Welcome to a better way, an authentic way. Welcome to Nature's Way. · Inside our minds, inside our hearts, inside our business, inside our bottles. · Our reason for being, the purpose that inspires our work e ...
-
Cellcom Customer Care Advocate
1 hour ago
Nsight Green Bay, United StatesJoining Cellcom: · Cellcom is an innovative wireless company that operates its own regional network to provide service for its customer base throughout Wisconsin and Upper Michigan. The company is respected for its long-standing reputation of delivering extraordinary customer ca ...
-
Velocity Enterprises Butte des Morts, United StatesAre you looking for a new professional challenge and enjoy working in a team? So do we, as we create convincing solutions with modern equipment in Butte des Morts. We offer SAP, real estate expertise, apps and portals, as well as consulting services to our more than 200 customers ...
-
Cellcom Repair Customer Care Specialist
2 weeks ago
Nsighttel Green Bay, United States** Position Description** · **Cellcom Repair Customer Care Specialist** Location **Cellcom (Bellevue) - Green Bay, WI** Employment Type **Full time** ***Cellcom is currently looking for a Repair Customer Care Specialist to join our team in Bellevue, WI.*** · ***Cellcom*** is an ...
-
SilverLinx Menasha, United StatesAre you a meat lover? Is meat your passion?We will teach you how to properly process, care for, and inspect meat and sausage products. · Half the sale is in the presentation: We will show you how to do it. · You will soon be able to advise customers on meat and sausage products a ...
-
Alta Resources Neenah, United StatesAlta Resources is Hiring · Summary · The Multi-Channel Customer Care Representative position provides professional, quality, and "best in class" service (and sales support) for existing or prospective customers by using a consultative approach that reflects the culture and phil ...
-
Home Carer
2 weeks ago
Aberdeenshire Council Appleton, United StatesJob Description · Location: Westhill area · Could you be instrumental in enabling people in their community to live as independently as possible? Are you the kind of person who wants more out of your job? Are you looking for a career that makes a real difference to people's live ...
Specialist I, Customer Care-Remote - Appleton, United States - Navitus
Description
Pharmacy Benefits Reinvented- As the industry's alternative pharmacy benefit manager (PBM), we're committed to making prescriptions more affordable for you and your members.
Here at Navitus, our team members work in an environment that celebrates creativity, fosters diversity and encourages growth. We welcome new ideas and share a passion for excellence.The Customer Care Specialist (CCS) will answer, research, and troubleshoot incoming Customer Care calls from members, providers, and pharmacies.
The Customer Care Specialist (CCS) will provide coverage for determinations, manual claims, and/or recoveries or other duties or projects as assigned.
The CCS will give accurate and timely responses to inquiries.The CCS will work with other team members to meet the departmental performance metrics and the CCS's main priority will always be answering any calls that are waiting.
The CCS will document all calls handled in a complete, clear, and concise manner.Is this you? Find out more below
How do I make an impact on my team?
