- 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
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Specialist I, Customer Care-Remote - Appleton, United States - Navitus Health Solutions LLC
Description
Job Description
Job DescriptionPharmacy 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.
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