Aston Carter Hiring for Customer Service Representative – REMOTE at Appleton, WI Full Time

Description:

Handles incoming calls regarding questions about a members prescription benefit. These calls include but are not limited to what a members copay would be, if a medication is covered, faxing forms to doctors for authorization on a medication before it can be prescribed, etc. You could explain a Customer Care Specialist does not negotiate drug costs with pharmacies, we are not a pharmacy, and are not an insurance company, we answer questions based on their pharmacy coverage .

What will my daily job duties look like?

• Understand, apply, and communicate client-specific prescription benefit and pharmacy claim processing information to include things like:

o formularies (list of covered medications),

o clinical programs to improve health and reduce costs,

o member out of pocket costs

o appeal rights

o prior authorization/exception processes

o and much more

• Educate members on how to best utilize their benefits
• Troubleshoot pharmacy claims real-time to include verifying information the pharmacy submits, comparing the claim result to benefit rules, and entering allowed overrides to allow claims to pay
• Send documents to providers electronically
• Follow up and provide superior service through outbound calls as necessary
• Anticipate and address questions to prevent repeat calls in order to delight customers and reduce customer effort
• Treat all customers with respect and display empathy
• Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements
• Deliver all relevant information timely, clearly communicating in a manner that ensures customer understanding
• Utilize resources consistently to incorporate changes in our fast-paced environment
• Adapt to fluctuations in workload from slower times to extremely busy times
• Effectively work/communicate with internal teams, such as other Customer Care team members, Prior Authorization, Manual Claims
• Maintain scheduled hours and demonstrate flexibility to aid in coverage
• Support mission statement in a professional manner

Skills:

Computer Skills, Customer Service, insurance verification, Inbound Call, Medical Claim, prior authorization, member service, prescription benefits

Additional Skills & Qualifications:

Must:

• Prior Medical customer service experience
• Excellent phone etiquette and typing skills (40wpm, 500kph)
• Basic knowledge of Microsoft Office and internet required. Will be reviewing documents of pharmacy benefits.
• Excellent oral and written communication skills
• Ability to hear needs and translate into correct resolution steps
• Ability to navigate systems efficiently and effectively while speaking
• Ability to balance quality with speed
• Ability to identify root cause of a problem from information presented
• Ability to use resources to solve problems independently
• Reliability including maintaining your schedule, consistently positive attitude and professional behavior at all times

Experience Level:

Entry Level

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About Aston Carter:

Please Note: Scammers are posing as Aston Carter. We’ll never contact you via Gmail, Telegram, or WhatsApp and we’ll never solicit money from you.

At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.

Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email [email protected] for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.