Servicing Representative

Independent Health Association; Buffalo (NY); Hybrid; USD 23,000 - 32,000; Full time

Job summary

Independent Health in Buffalo, NY is seeking a Servicing Representative to deliver outstanding customer service to Pharmacy Benefit Dimensions customers. You will advocate for members, resolve inquiries across phone, mail, fax, and email, and utilize system tools to clarify benefits and eligibility.

The role emphasizes empathetic listening, accurate documentation, and adherence to CMS rules. Hybrid work with 2 days in office and 3 days remote; high-volume calls expected.

Qualifications

• High school diploma or GED required; Associates degree preferred.
• Six (6) months of experience in health insurance, physician's office or pharmacy.
• Experience in call center operations and handling high volume calls.
• Excellent written and verbal communication skills.
• Ability to document accurately and navigate multiple systems.

Responsibilities

• Act as a customer advocate by providing excellent service via phone, written correspondence, and walk-in members; de-escalate and resolve complaints.
• Provide accurate benefit, policy and eligibility information; communicate resolutions to inquiries.
• Ensure compliance with CMS rules and regulations and log all contacts in appropriate systems.
• Meet quality, productivity and accuracy targets as measured by scorecards.
• Maintain up-to-date knowledge of contracts, benefits and policies; participate in required trainings.

Skills

Customer service

Call center

Communication skills

Empathetic listening

Typing speed 35-40 wpm

Problem solving

Multi-system navigation

Education

High school diploma or GED

Associates degree preferred

Tools

CMS systems

Phone systems

Job description

FIND YOUR FUTURE

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

This is a hybrid opportunity working 2 days in office and 3 days work from home. Only WNY candidates will be considered.

Overview

The Servicing Representative is a customer service professional who will display confidence, a passion for service, and practice empathetic listening towards all Pharmacy Benefit Dimensions (PBD) customers. The Servicing Representative will function as an advocate for all customers and resolve all inquiries (i.e., phone, mail, fax, and email). They will utilize system tools and resources to address and resolve inquiries; provide benefit clarification and eligibility; communicate claim and reimbursement information, facilitate proper utilization of policies and procedures, coordinate resolution to streamline processes; make demographic changes; and educate customers on regulatory policies and procedures.

Qualifications

• High school diploma or GED required. Associates degree preferred.
• Six (6) months of experience working for a health insurance company, physician's office or pharmacy required. Experience handling self-funded pharmacy calls preferred.
• Experience in a call center operations environment preferred.
• Ability to effectively communicate with internal and external customers. Excellent written and verbal communication skills, excellent customer service skills.
• Experience handling high volume, inbound and outbound phone calls preferred.
• Ability to listen with intent to understand.
• Proficient in verbally translating written communication. Typing 35-40 words per minute is required.
• Proficient in problem solving with the ability to prioritize accordingly.
• Ability to utilize multiple system tools simultaneously.
• Strong organizational and time management skills.
• Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Essential Accountabilities

• Act as a customer advocate by providing excellent customer service when answering phone calls, written correspondence and servicing walk-in members in a timely fashion. De-escalate customers as needed and resolve customer complaints.
• Ensure that our customers are obtaining accurate and up-to-date information on policies and procedures and communicate a successful resolution to inquiries.
• Ensure compliance with all CMS rules and regulations.
• Log all contacts into appropriate systems.
• Meet or exceed all department standards in the following categories as measured and recorded by the representative's scorecard:
  • Quality goals - measure ability to consistently respond to customers with excellent customer service.
  • Productivity goals - measure ability to be productive and use time effectively and efficiently to include average talk plus hold time, after call work (ACW), adherence, use of non-available states, tardiness and attendance.
  • Accuracy goals - measure ability to respond to inquiries correctly and accurately.
• Maintain technical knowledge regarding Pharmacy Benefit Dimensions' contracts and benefits and working knowledge of policies and procedures while maintaining updates daily. Attend required training sessions as needed.
• Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards (NCQA, State, CMS etc.), addressing first-level complaints and providing assistance on appeals as needed; receive and effectively resolve written inquiries from members regarding claims, benefits, eligibility, reimbursement and participating providers.
• Knowledge of all systems and training manuals and the ability to coordinate the use of these tools at the same time.
• Other duties as required by immediate supervisor which may include servicing walk-in members, correspondence support and making outbound phone calls.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $20.00 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity /affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.