Hybrid Customer Service Advocate

The Pharmacy Customer Service Advocate assists member, providers, and pharmacies with inquiries for member's eligibility, claim status, precertification requirements, and claims coverage questions by phone, fax, email, and US mail, working independently within the scope of their duties. The Customer Service Advocate coordinates the handling of numerous daily, time-sensitive functions required to maintain an efficient workflow and direct all maters to a proper resolution.

Responsibilities
* Review issues as they arise
* Interpret plan documents/plan guidelines
* Escalate difficult issues to the appropriate party
* Forward all records to the appropriate parties
* Accurate and complete documentation of all daily interactions
* Provide exceptional customer service for incoming/outgoing calls
* Serve as a role model in demonstrating core values of customer service
* Maintain and enter information into systems as information is received
* Provide timely and thorough responses to internal and external customers
* Maintain up to date knowledge on industry trends and look for new data sources
* Record and respond to calls/emails/faxes from Member, Providers, and Pharmacies
* Maintain HIPAA/PHI guidelines to ensure the confidentiality of all calls and documents
* Determine eligibility by reviewing, researching, and analyzing information in the appropriate system
* Maintain high level of knowledge to answer specific Pharmacy Plan Benefit information or sharing guideline related questions

Skills and Abilities
* Excellent verbal and written communication skills with high attention to detail
* Excellent customer service skills
* Strong analytical and problem-solving skills
* Confident decision-making abilities
* Demonstrated ability to work independently, prioritize workloads, multi-task effectively, and manage priorities to meet deadlines

Requirements
* Bilingual is preferred
* Pharmacy or PBM Call Center Experience
* High school diploma or equivalent required
* Knowledge of medical/pharmaceutical terminology required
* Health Insurance/Eligibility and Benefit knowledge required
* Minimum 2 years customer service or claims experience in the Health Insurance Industry

Pay Rate
* $21.15 to $23.50 an hour

Schedule
* Training Schedule is the first 1-2 months: Monday to Friday, 7:00AM to 4:00PM.
* Post-Training Schedule: After training, you'll be assigned an 8-hour shift (plus a 1-hour lunch) between 5:00AM to 6:00PM.
* Your exact schedule will be determined during training based on business needs.
* Saturday Rotation: You'll be required to work approximately one Saturday per month, from 8:00AM to 12:00PM, with overtime pay for these hours.