Customer Service Representative-
Receive inbound calls from beneficiaries enrolled into a PDP or MAPD program. Assist beneficiaries with updating account information, providing plan information, resolving issues with utilization of the plan, and taking new orders or reorders for products sponsored by the plan(s), e.g., OTC.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Update account information such as billing options and changes of address or phone numbers.
Research premium billing discrepancies and prescription claims processed.
Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage.
Submit mail requests for beneficiaries such as ID cards and formularies.
Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered provide an explanation as to why.
Make concise and detailed notations as it pertains to member records.
Assist pharmacies with prescription denials and errors and verifying benefits.
Advise providers on how to get prior authorizations on medicines prescribed with restrictions such as step therapy and quantity limits.
Requirements High school diploma or equivalent.
Some previous customer service experience is preferred or any equivalent combination of related training and experience.
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Monster - 12 months ago