Job Description

Location Remote

Position Responsibilities

• Efficiently triage incoming phone calls with professional phone etiquette from members pharmacies, and providers with minimal support. Ask probing questions to identify and resolve all issues and address concerns promptly
• Identify, accurately document, and escalate member, pharmacy, and medical claims concerns to the appropriate internal team including various members of the Operations Team
• Effectively communicate issues and solutions to members, pharmacies, providers and relevant internal stakeholders to ensure customers receive quality care and that the resolution meets all health and safety standards
• Communicate effectively with internal and external customers to provide first-call resolution and de-escalate customer concerns
• Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast-paced, environment
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
• Support the Fraud, Waste, and Abuse program by reviewing pharmacy and medical claims information and communicating findings to appropriate internal staff
• Work with multiple systems, up to 2 monitors, and multitask in a fast-paced environment
• Self-starter who displays a positive attitude, strong work ethic, and excellent attendance
• Meet all departmental goals including schedule adherence, attendance, and quality monitoring
• Standard hours for training: Monday thru Friday, 9:00am – 5:30pm, Eastern
• Perform other customer support duties as assigned
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Required Qualifications

• High school diploma or the equivalent; Associates or Bachelor’s degree preferred
• 2+ years of customer service, call center, and/or health care experience with a passion for building customer loyalty through exceptional listening, relationship building, and strong written and verbal communication preferred
• 2+ years of medical claims or related Health Care experience required
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, fast-paced, metric-driven call center environment
• Bilingual Spanish highly preferred
• Medicare experience preferred

Hourly Rate: $26.00