Healthcare Customer Service Representative

Staffing Solutions Organization LLC (SSO); Augusta (ME); Hybrid; USD 25,000 - 28,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with discretionary employer 0%–

Paid time off and holidays

Flexible spending accounts (FSA)

Job summary

Staffing Solutions Organization LLC (SSO) is seeking a Healthcare Customer Service Representative – Pharmacy Benefits in Augusta, ME. The role supports MaineCare members, pharmacies, and providers with customer service, education, and technical assistance related to prescription coverage and MaineCare pharmacy benefits.

The position offers three days of telework per week with management approval and requires strong communication, attention to detail, and policy application.

Qualifications

• Proficiency with modern office practices and software.
• Ability to make independent decisions within established procedures.
• Knowledge of Medicare, MaineCare, or healthcare program operations.
• Knowledge of graphics, publications, and electronic content management.
• Ability to interpret and apply laws, rules, policies, and procedures.
• Strong planning and organizational skills.

Responsibilities

• Respond to inbound calls from MaineCare members, pharmacists, technicians, and other stakeholders.
• Educate members on Medicare Part D plans, MaineCare pharmacy benefits, and related programs.
• Assist members with enrollment, coverage questions, and benefit explanations.
• Resolve issues related to copays, deductibles, and medication access.
• Support claims processing activities including evaluation, pricing, and service requests.
• Create, edit, and manage correspondence, reports, and informational materials.
• Coordinate and present training, workshops, and orientation sessions.
• Comply with state policies, information security standards, and confidentiality requirements.

Skills

Office software

Customer service

Communication

Attention to detail

Job description

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