Specialty Customer Service Representative I

Pharmacy Benefit Management Representative

Provides outstanding customer service to pharmacies, physicians, health plan sponsors, and their members, beneficiaries, or employees by responding to and resolving phone inquiries and fax referrals related to specialty benefit information, formulary management, eligibility verification, prior authorization, and other PBM processes.

Essential duties and responsibilities include the following. Other duties may be assigned.

• Convey a positive image of the company by promptly responding to customer phone inquiries, faxes, and emails and determining the appropriate actions to resolve issues, gather and provide information, and offer assistance.
• Deliver service that meets or exceeds department performance standards for Average Hold Time, Abandonment Rate, Talk Time, Quality, and Schedule Adherence.
• Meet required turnaround times for processing incoming faxes and forwarding on to the appropriate Specialty Pharmacy Fulfillment Partner (SPFP).
• Utilize the Specialty Service Center application to provide necessary information to specialty pharmacies in addition to the referral form, in order to expedite the fulfillment process for MID Specialty client members.
• Utilize multiple company database programs to research and resolve complex issues relating to benefit information, formulary compliance, eligibility verification, prior authorization, and other PBM processes.
• Provide information to MID Specialty clients, members, pharmacies and physicians about benefit plan restrictions, member eligibility, prior authorization requirements, and other PBM functions as specified by health plan sponsors.
• Follow up with callers (clients, members, pharmacies and physician provider offices) as appropriate to ensure customer satisfaction and timely response to requests. Diffuse irate or emotionally upset customers by actively listening to issues, calming the customer, and providing positive solutions to resolve concerns.
• Represent MedImpact in a positive manner by adhering to established procedures and guidelines. Support the corporate strategy by delivering Flawless Fundamentals through telephone courtesy, prompt response to callers, anticipation of customer needs and concerns, solution-oriented problem solving, and adherence to scripts, greetings, and call closing messages when applicable. Identify opportunities and make recommendations to department leadership for improvement of workflow processes, operating systems, training programs, reference materials, and quality initiatives that enhance the customer experience.
• Keep current on new plan information and instructions by attending and participating in staff meetings, company-required training programs, and other activities that develop skills, build teamwork, and provide updated information.

Supervisory Responsibilities: No supervisory responsibilities

Client Responsibilities: This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience: GED/HS Diploma and 6+ months' experience or equivalent combination of education and experience

Computer Skills: Intermediate knowledge of MS Office/Word, Excel, and Outlook and aptitude for new programs. Experience with Windows based database programs is also required.

Other Skills and Abilities: Demonstrated ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment. Demonstrated ability to meet or exceed the competencies as listed.

Reasoning Ability: Ability to apply common sense understanding to carry out simple one- or two-step instructions. Ability to deal with standardized situations with only occasional or no variables. Ability to define problems, collect data, establish facts, and draw valid conclusions.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills: Ability to respond effectively to the most sensitive inquiries or complaints. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.

Competencies To perform the job successfully, an individual should demonstrate the following competencies: Composure, Decision Quality, Organizational Agility, Problem Solving, Customer Focus, Drive for Results, Peer Relations, Time Management, Dealing with Ambiguity, Learning on the Fly, Political Savvy.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., "close vision") to accurately read fine print, view computer screens, and handle small objects. Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes, or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).

Work Location: This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.

Working Hours: This is a full-time non-exempt position requiring one to be able to work overtime from time to time to get the job done. Therefore, one must have the ability to work nights, weekends or on holidays as required. This may be changed at any time to meet the needs of the business. The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm.

Travel: This position requires no travel; however, attendance may be required at various local conferences and meetings.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.