CSR/Pharm Tech

» CSR/Pharm Tech
Call Center & Customer Service
in Jacksonville
, FL
Reference: 19-03347

Responsibilities:

  • Actively listen and probe callers in a professionally and timely manner to determine purpose of the calls
  • Research and articulately communicate information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality
  • Resolve customer administrative concerns as the first line of contact
  • Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies
  • Assist in the mentoring and training of new staff
  • Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal)
  • Comprehensively assemble and enter patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs
  • Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members
  • Educate providers on how to submit claims and when/where to submit a treatment plan
  • Identify and respond to crisis calls and continue assistance with the clinician until the call has been resolved
  • Inform providers and members on appeal process
  • Lead or participate in activities as requested that help improve care center performance, excellence and culture
  • Link or make routine referrals and triage decisions not requiring clinical judgment
  • Perform necessary follow-up tasks to ensure member needs are completely met
  • Provide information regarding in-network and out-of-network reimbursement rates and states multiple networks to providers
  • Refer callers requesting provider information to provider services regarding professional provider selection criteria and application process
  • Refer patients/EAP clients to the Care Management team for a provider, EAP affiliate, or facility
  • Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers
  • Support team members and participate in team activities to help build a high-performance team

Qualifications:

  • Associates degree, Bachelor’s degree, GED (required), High School diploma (required)
  • License and Certifications (required)
  • License and Certifications (preferred)

Responsibilities:

  • Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment
  • Responsible for meeting call handling requirements and daily telephone standards as set forth by management
  • Must agree to observing service for the purpose of training and quality control
  • Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills
  • Must be able to maneuver through various computer platforms while verifying information on all calls
  • Must be able to talk and type simultaneously