Customer Service Specialist

This is a fully remote position, open to applicants in Alabama, +15 more states.

📋 Description

• Establish reliable relationships with clients, claimants, and pharmacies by delivering outstanding customer service to every caller.

• Address phone inquiries concerning claims adjudication, eligibility verification, prior authorization, Pharmacy Benefit Management, Ancillary Benefits Management, and certain functions of the Billing Verification Department.

• Collaborate with the Team Lead, Supervisor, and Manager to resolve inquiries effectively.

• Utilize verbal and written communication, listening, organizational, problem-solving, and reasoning skills to address customer concerns.

• Comply with attendance, punctuality, and quality standards.

• Simplify jargon and complex processes into clear, step-by-step guidance.

• Manage challenging customers and situations with detail, patience, professionalism, and empathy.

• Tailor communication strategies to suit various member styles and personalities.

• Take initiative and accept responsibility when appropriate.

⛳️ Requirements

• A high school diploma or general education degree (GED) along with one to two years of relevant customer service and/or healthcare experience is required; or an equivalent combination of education and experience.

• Proficiency in Windows-based applications.

• Capacity to multitask utilizing dual monitors.

• Ability to quickly enter data using a keyboard.

• Reliable, high-speed internet access with adequate bandwidth.

• A private workspace free from distractions and noise.

• Flexibility to work varying or rotating shifts, as well as overtime, weekends, and holidays when necessary.

• Capability to read prescription drug names.

• Ability to follow simple instructions and write brief correspondence/memos.

• Prior experience in an administrative business environment is highly preferred.

• Experience in the healthcare sector is preferred.

• Candidates must reside in one of the preferred hiring states: Alabama, Arizona, Florida, Georgia, Idaho, Indiana, Maryland, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, or Virginia.

• Travel may be required to attend meetings and visit locations across the country.

🏝️ Benefits

• Work-From-Home model.

• Healthcare coverage.

• Paid Time Off (PTO).

• Paid holidays.

• 401(k) / 401k contribution.

• Company-provided life insurance.

• Disability coverage/insurance.

• Health, dental, and vision insurance.

• Wellness options and resources.

• Recognition programs.

• Statutory benefits, including Colorado HFWA where applicable.

• Company laptop provided.

• Reasonable accommodations for individuals with disabilities.