Customer Service Specialist

Rose International
May 28, 2021
Atlanta, GA
Job Type


Position Title: Client Services Specialist I- Med D PBM Technician Rep 1

Position Number: 369649

Location: Work at Home 99999

Position Type: Temporary

Required Skill Set:

Billing, Communications, Customer Service, Microsoft Excel, Microsoft Word, WebEx

Position Description:

**Only U.S. Citizens and those authorized to work in the U.S. can be considered as W2 candidates.**
Anticipated Start Date: 07/19/2021
Anticipated End Date: 11/15/2021
Title: Client Services Specialist I- Med D PBM Technician Rep 1
Location: Working Offsite from Caremark Location anywhere in US, Please note: Actual location may vary, RI, USA, 02895

• Pharmacy Appeals Representative I.

In this role, you will be Responsible for:
• Utilizing multiple software systems to complete Medicare appeals case reviews.
• Meeting or exceeding government mandated timelines.
• Complying with turnaround time, productivity and quality standards.
• Conveying resolution to beneficiary or provider via direct communication and professional correspondence.
• Acquiring and maintaining basic knowledge of relevant and changing Med D guidance.

Required Qualifications:
• Accountable and results driven.
• Critical thinker/problem solver.
• Receptive to constructive feedback and flexible in adapting to change.
• Ability to effectively plan, prioritize, and organize time and workload.
• Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment.
• Proficient in navigation of multiple computer applications.
• Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors.
• Ability to type more than 30 WPM.

Preferred Qualifications:
• At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service.
• Six months of PBM/pharmaceutical related work strongly desired.
• Opportunity for full-time employment contingent on performance.
• Virtual interviews with supervisors over Webex or phone.
• Hours of operation 8-8 est M-F with rotating weekend.

• Customer service focus.
• Basic experience in MSWord and MS Excel.
• Familiar with medical terminology and knowledge of medical coding.
• Ability to read and interpret billing documents.
• The position also requires an extensive amount of data entry work.

• 2 years’ experience.
• Strong Attention to detail.
• Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality.
• Proficient computer skills and the ability to navigate in a Windows based environment.
• Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible.
• Ability to work in a high pressure, time sensitive environment.
• Project a professional business image, through phone interaction as well as internal communications.
• Demonstrated problem-solving ability and attention to detail.
• Demonstrated sense of urgency with assignments.
• Strong organizational skills.
• Strong telephone skills.
• Ability to read and understand pharmacy/medical terminology.
• Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations.
• Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations.
• Ability to perform basic mathematic calculations maybe required.
• Ability to interpret a variety of work instructions provided through a variety of mediums.
• Ability to anticipate needs and resolve issues with urgency.
• Ability to consistently meet quality and production standards.
• Displays confidence in the ability to learn complex material.
• Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results.

Position Summary:
• Must apply information [provided through multiple channels] to the plan criteria defined through work instruction.
• Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
• Responsible for research and correction of any issues found in the overall process.
• Phone assistance is required to initiate and/or resolve coverage requests.
• Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed.
• Must maintain compliance at all times with CMS and department standards.
• Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.

• High School Diploma or GED required.
• Associates degree in Business, Accounting or equivalent work experience preferred.
• Bachelor’s degree in related field or equivalent work experience preferred.
For information and details on employment benefits offered, visit here . If you have any questions/concerns, please contact our HR Department via our secured website .
Drop files here browse files ...

Related Jobs

Account Director   Atlanta, GA new
June 13, 2021
Area Marketing Manager   San Antonio, TX new
June 13, 2021
June 12, 2021
June 12, 2021