The Pharmacy Customer Service Advocate assists member, providers, and pharmacies with inquiries for memberās eligibility, claim status, precertification requirements, and claims coverage questions by phone, fax, email, and US mail.
Requirements
- Maintain HIPAA/PHI guidelines
- Interpret plan documents/plan guidelines
- Determine eligibility
- Use critical thinking and reasoning
- Maintain and enter information into systems
- Forward all records
- Record and respond to calls/emails/faxes
- Maintain high level of knowledge
- Review issues
- Serve as a role model
- Provide timely and thorough responses
- Escalate difficult issues
- Provide exceptional customer service
- Propose process improvements
- Ensure compliance with service standards
- Develop and execute plans
- Provide continuous feedback
- Work cross-departmentally
- Maintain up to date knowledge
- Develop or improve current internal processes
- Accurate and complete documentation of all daily interactions
Benefits
- 401k Matching
- Retirement Plan