Experienced Remote Healthcare Customer Service Representative - Prescription Benefit Support Specialist

Transforming Healthcare through Exceptional Customer Service

At TEKsystems, we're passionate about empowering clients to activate innovative solutions and capitalize on new opportunities. As a leading provider of Full-Stack Technology Services, Talent Services, and real-world applications, we collaborate with forward-thinking leaders to drive meaningful change. We're now seeking an experienced Remote Healthcare Customer Service Representative to join our dynamic team and make a positive impact on the lives of our clients.

About the Role: Prescription Benefit Support Specialist

As a Customer Care Specialist, you will be the primary point of contact for members seeking assistance with their prescription benefits. Your expertise and dedication will enable us to deliver exceptional customer experiences, foster loyalty, and drive long-term relationships. You will work in a fast-paced environment, handling a high volume of calls, and resolving complex issues with precision and empathy.

Key Responsibilities:

• Respond to member inquiries regarding prescription benefits, including copays, medication coverage, and prior authorization processes.
• Effectively communicate client-specific information, such as formularies, clinical programs, and appeal rights, to ensure members understand their benefits.
• Troubleshoot pharmacy claims in real-time, verifying information, comparing claim results to benefit rules, and entering allowed overrides to facilitate claims processing.
• Electronically send documents to healthcare providers, ensuring timely and secure communication.
• Make outbound calls to follow up on member issues, providing superior service and resolving outstanding matters.
• Anticipate and address member questions proactively, reducing the likelihood of repeat calls and enhancing overall customer satisfaction.
• Maintain the highest standards of customer service, treating all members with respect, empathy, and professionalism.
• Protect sensitive personal health information and adhere to HIPAA regulations and confidentiality requirements.
• Stay up-to-date with changing benefit information, utilizing resources to incorporate updates and ensure accurate communication.
• Collaborate with internal teams, including Prior Authorization and Manual Claims, to resolve complex issues and drive efficient processes.
• Demonstrate flexibility and adaptability in response to fluctuations in workload, maintaining scheduled hours and a positive attitude.

Essential Qualifications:

• 2+ years of experience in medical customer service, preferably in a prescription benefit or healthcare-related environment.
• Excellent phone etiquette and typing skills (40 wpm, 500 kph), with the ability to navigate multiple systems efficiently.
• Basic knowledge of Microsoft Office and internet applications, with experience reviewing documents related to pharmacy benefits.
• Strong oral and written communication skills, with the ability to articulate complex information clearly and concisely.
• Proven ability to identify root causes of problems, utilize resources to resolve issues independently, and balance quality with speed.
• Reliability, including maintaining a consistent schedule, positive attitude, and professional behavior.

Preferred Qualifications:

• Experience working in a fast-paced, dynamic environment with a high volume of customer interactions.
• Familiarity with healthcare industry trends, regulations, and best practices.
• Knowledge of pharmacy benefits, clinical programs, and prior authorization processes.
• Strong analytical and problem-solving skills, with the ability to interpret complex data and make informed decisions.

Skills and Competencies:

To succeed in this role, you will need to possess a unique blend of skills and competencies, including:

• Excellent communication and interpersonal skills, with the ability to build rapport with members and healthcare professionals.
• Strong analytical and problem-solving skills, with the ability to navigate complex systems and resolve issues efficiently.
• Adaptability and flexibility, with the ability to respond to changing priorities and workload fluctuations.
• Attention to detail, with the ability to accurately process and communicate sensitive information.
• Empathy and compassion, with a commitment to delivering exceptional customer service and support.

Career Growth Opportunities and Learning Benefits:

At TEKsystems, we're committed to helping our team members grow and develop their skills. As a Remote Healthcare Customer Service Representative, you will have access to ongoing training and development opportunities, enabling you to enhance your knowledge and expertise in the healthcare industry. Our comprehensive onboarding program will equip you with the skills and confidence needed to excel in your role, and our experienced team will provide guidance and support throughout your tenure.

Work Environment and Company Culture:

As a remote team member, you will enjoy the flexibility and autonomy of working from home, while remaining connected to our vibrant and inclusive company culture. We're committed to fostering a collaborative and supportive environment, where team members can share ideas, learn from each other, and grow together. Our company values diversity, equity, and inclusion, and we're proud to be an equal opportunity employer.

Compensation, Perks, and Benefits:

We offer a competitive compensation package, including a comprehensive benefits program and opportunities for career advancement. As a TEKsystems team member, you will enjoy a range of perks, including flexible work arrangements, professional development opportunities, and a dynamic work environment.

Join Our Team: Make a Meaningful Impact in Healthcare

If you're a dedicated and compassionate customer service professional looking to make a positive impact in the healthcare industry, we encourage you to apply for this exciting opportunity. As a Remote Healthcare Customer Service Representative, you will play a critical role in delivering exceptional customer experiences, driving loyalty, and fostering long-term relationships. Join our team at TEKsystems and become part of a dynamic and inclusive community that's passionate about transforming healthcare through innovative solutions and exceptional customer service.

Apply now and take the first step towards a rewarding career in healthcare customer service!