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Customer Care Specialist (Inbound Call Center Environment) in Appleton, WI at Impact Management

Date Posted: 3/7/2019

Job Snapshot

Job Description

Impact Management Services has a client located in the Appleton, WI area  seeking a Customer Care Specialist to work in an exciting call center environment.  

This is a contract to direct hire opportunity that will offer competitive compensation and an opportunity to advance within the company.

If interested, please apply today for immediate consideration.

The Customer Care Specialist (CCS) will answer, research, and troubleshoot incoming Customer Care inquiries from members, providers, and pharmacies on all topics. 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 ensure their main priority will always be answering any inquiries that are waiting. The CCS will document all inquiries handled in a complete, clear, and concise manner.

The Customer Care Specialist (CCS) will become proficient in the Navitus claim processing system, consolidated desktop application, and Intranet. The CCS will gain proficiency in understanding, applying, and communicating client-specific formularies, clinical programs, and other pharmacy benefit components. The CCS will learn and understand general pharmacy benefit management and health care industry terminology and practices. The CCS will understand how to handle requests coming in through multiple channels.

Additional Responsibilities:       

  • Research and analyze 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, status, 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.
  • Anticipate and address questions which may drive repeat calls. 
  • Respond to and resolve all internal and external inquiries in a timely, accurate, and complete manner.
  • Utilize all available resources to ensure that the correct and complete answer is given to all inquiries.
  • Prioritize work appropriately and as assigned by leadership.
  • Learn and apply processes and changes to those processes.
  • Learn, abide by, and help enforce all departmental procedures.
  • Actively participate in team meetings, coaching sessions, and daily operations.
  • Participate in ad hoc or regularly scheduled projects.
  • Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements.
  • Participate in mandatory and voluntary learning opportunities and apply new information appropriately.
  • Utilize non-phone work time for personal and professional development through such activities eLearning classes, participation in the Navitus CPhT program, and by continually reviewing all available resources used in successful call handling.
  • Support multi-channel communications.
  • Maintain scheduled hours and demonstrate flexibility to aid in hour coverage.
  • Support the Navitus mission statement in a professional and responsible manner.

Essential Background Requirements:

Education:  A high school degree or equivalent. Post high school education preferred.

Experience:  Excellent customer service, phone etiquette and typing skills required. Basic knowledge of Microsoft Office and internet required. 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.

Key Skills/Competencies:

  • Ability to prioritize continually/multi-task
  • Ability to balance quality with speed
  • Excellent critical thinking, problem-solving, and research skills
  • Ability to distill problems and satisfy customers quickly
  • Professional business acumen including attendance, adherence, attitude and behavior
  • Drive to learn new skills and willingly share knowledge with others
  • Affinity for delivering outstanding service; customer-centric
  • Ability to understand internal and external customer needs
  • Ability to use sound judgment in making service-oriented decisions
  • Teamwork/Collaboration
  • Excellent communication skills (written, verbal/presentation and active listening).
  • Understanding and coping with constant change
  • Ability to work within multi channels (email, phone, chat, etc.)

If interested, please apply today for immediate consideration.