Customer Care Associate

Orlando, FL 32812

Post Date: 01/18/2018 Job ID: 25562 Category: Pharmacy

Job Description:
  • This position is a frontline service position providing assistance to the Client s members and providers regarding programs, policies, and procedures.
  • Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
  • Resolves customer administrative concerns as the first line of contact; this may include claim resolutions and other expressions of dissatisfaction.
  • 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 assembles and enters 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 and help the client achieve its business and operational goals.
  • Educates providers on when/where to submit a treatment plan.
  • Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
  • Informs providers and members on the clients appeal process.
  • Lead or participate in activities as requested that help improve Care Center performance, excellence and culture.
  • Links or makes routine referrals and triage decisions not requiring clinical judgment.
  • Performs necessary follow-up tasks to ensure member or provider's needs are completely met.
  • Provides information regarding Client s in-network and out-of-network reimbursement rates and states multiple networks to providers.
  • Refers callers requesting provider information to Provider Services regarding Client s professional provider selection criteria and application process.
  • Refers patients/EAP clients to the Client s 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.
  • Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.

Requirements:
  • Must be registered with FL State Board of Pharmacy.
  • 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.
  • Must be flexible in scheduling and comfortable with change - customer service is an ever-changing environment.
  • Must agree to observing service for the purpose of training and quality control.

For more information, please contact our office at 877-782-3334.

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