Healthcare Customer Service Representative

Healthcare Customer Service Representative Pharmacy Benefits

Location: Augusta, ME

This position allows for 3 days of telework per week with management approval.

Pay Range: $18.00 per hour

Position Overview:

The Healthcare Customer Service Representative Pharmacy Benefits supports MaineCare members, pharmacies, and healthcare providers by providing customer service, education, and technical assistance related to prescription coverage, Medicare Part D, and MaineCare pharmacy benefits. This role requires strong communication skills, attention to detail, and the ability to apply policies and procedures accurately.

Key Responsibilities:

Customer & Member Support

• Respond to inbound calls from MaineCare members, pharmacists, technicians, and other stakeholders.
• Educate members on Medicare Part D plans, Medicare Savings Programs, and MaineCare pharmacy benefits.
• Assist members with enrollment, coverage questions, and benefit explanations.
• Resolve issues related to copays, deductibles, premiums, medication access, and prescription fills.
• Support members who are out of medication or unable to fill prescriptions.

Claims & Coverage Support

• Review insurance coverage for pharmacies, providers, hospitals, and members.
• Support claims processing activities including evaluation, pricing, and service requests.
• Apply rules, regulations, policies, and documentation requirements to individual cases.

Administrative & Technical Support

• Create, edit, and manage correspondence, reports, and informational materials.
• Develop and maintain computerized forms, graphics, charts, tables, and web content.
• Examine documents, identify errors or irregularities, and take corrective action as authorized.
• Perform routine administrative duties including scheduling, coordinating meetings, and responding to inquiries.
• Track and monitor contracts, licenses, fees, and reports; reconcile funds as required.

Training & Leadership (as assigned)

• Coordinate and present training, workshops, and orientation sessions.
• Develop standard work procedures within established guidelines.
• Provide work direction and support to team members as needed.
• Confer with supervisors on performance matters when applicable.

Compliance

• Comply with all State policies, information security standards, and confidentiality requirements.

Minimum Qualifications:

• Training, education, or experience in office or administrative support demonstrating:
• Proficiency with modern office practices and software
• Ability to make independent decisions within established procedures
• Knowledge or ability to learn:
• Medicare, MaineCare, or healthcare program operations
• Graphics, publications, and electronic content management
• Information distribution via the internet and web pages
• Demonstrated ability to:
• Prepare business correspondence and standard reports
• Interpret and apply laws, rules, policies, and procedures
• Detect errors, analyze information, and resolve problems
• Present information clearly to individuals and groups
• Exercise sound judgment and attention to detail
• Strong customer service, communication, and organizational skills

Benefits (Through SSO)

SSO offers a competitive benefits package, including:

• Medical, dental, and vision insurance
• 401(k) with discretionary employer match
• Paid time off and paid holidays
• Flexible spending accounts (FSA)
• Additional employee perks

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role.

Applicants must be authorized to work in the U.S. This position is not eligible for work authorization sponsorship (including H-1B sponsorship) by SSO and under the federal laws relating to the F-1 STEM EAD program, this position is not eligible to support a STEM EAD extension application.

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an E-Verify participant.