Customer Support Specialist

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Respond to telephone inquiries in a friendly, professional, and efficient manner, ensuring outstanding customer service.

• Record all incoming calls and conversations in the claims adjudication software.

• Provide clients with information regarding plan policies, benefits, and procedures.

• Address client drug benefit issues related to medical, financial, or technological aspects.

• Initiate and manage prior authorization requests.

• Conduct outbound calls to pharmacies and plans to assist in the resolution of JIRA tickets.

• Review the after-hours call log and complete any necessary follow-up.

• Submit JIRA tickets for compound prescriptions.

• File JIRA tickets to address NDC issues, including pricing discrepancies and missing NDCs.

• Maintain up-to-date knowledge of plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.

• Accept additional responsibilities as assigned, which may include direct member reimbursement, processing, handling manual claims, reporting, and investigating rejected claims.

• Ensure that HIPAA guidelines are adhered to in all communications with clients.

⛳️ Requirements

• Associate’s degree or a comparable combination of education and work experience.

• CPhT (Certified Pharmacy Technician) Certification is preferred.

• At least 3 years of experience in customer service or member service within a call center or similar environment.

• A minimum of 2 years of experience in the healthcare sector.

• At least 2 years of experience in a pharmacy support position.

• Familiarity with plan and benefit structures as well as Medicare guidelines.

• Understanding of pharmacology and pharmacological terminology.

• Exceptional communication skills and professionalism in client interactions.

• Capability to resolve issues under pressure by making swift decisions while on calls.

• Detail-oriented with the ability to manage and prioritize workload effectively.

• Proficient in computer use, including word processing, spreadsheet management, and database software.

🏝️ Benefits

• Medical, dental, and vision coverage beginning on the first day of the month following the date of hire.

• Flexible spending options.

• Company-sponsored life insurance and short-term disability coverage.

• Voluntary benefits available.

• 401(k) retirement plan.

• Paid Time Off.

• Paid holidays.