Servicing Representative

Jobtailor; Buffalo (NY); On-site; USD 34,000 - 46,000; Full time

Job summary

Jobtailor is seeking a customer service advocate in Buffalo, NY to deliver outstanding service via phone, email, and in-person member interactions. You will de-escalate issues, provide policy information, and ensure CMS/NCQA regulatory compliance while logging interactions across systems.

Ideal candidates have 6 months in health insurance or pharmacy settings, strong written and verbal communication, and the ability to handle high-volume calls. Training and ongoing development are provided.

Qualifications

• High school diploma or GED required
• Associate degree preferred
• Six (6) months of experience in health insurance, physician’s office, or pharmacy
• Experience handling high-volume calls preferred
• Excellent written and verbal communication skills

Responsibilities

• Provide excellent customer service via phone, written correspondence, and walk-in servicing
• De-escalate customer issues and resolve complaints
• Provide accurate policy/procedural information and document resolutions
• Ensure CMS and NCQA compliance
• Log contacts into appropriate systems and meet quality metrics
• Maintain knowledge of Pharmacy Benefit Dimensions contracts, benefits, and procedures
• Attend required trainings and participate in ongoing education
• Document customer information to meet regulatory standards
• Handle first-level complaints and assist with member appeals
• Resolve inquiries about claims, benefits, eligibility, and reimbursement
• Coordinate use of multiple systems and resources
• Perform additional duties including outreach and correspondence support

Skills

Customer service

Call center

CMS compliance

Problem solving

Communication skills

Education

High school diploma or GED

Associate degree preferred

Tools

Multiple system tools

Training manuals

Job description

• Act as a customer advocate by providing excellent customer service via phone calls, written correspondence and walk-in member servicing
• De-escalate customers and resolve customer complaints
• Provide accurate and up-to-date information on policies and procedures and communicate successful resolutions
• Ensure compliance with all CMS rules and regulations
• Log all contacts into appropriate systems
• Meet or exceed quality, productivity and accuracy goals measured by the representative’s scorecard
• Maintain technical knowledge of Pharmacy Benefit Dimensions’ contracts, benefits, policies and procedures, including daily updates
• Attend required training sessions
• Document pertinent customer information in appropriate systems to meet NCQA, State and CMS regulatory standards
• Address first-level complaints and assist with appeals
• Resolve written member inquiries regarding claims, benefits, eligibility, reimbursement and participating providers
• Coordinate use of multiple systems and training manuals simultaneously
• Perform other duties as required, including walk-in member servicing, correspondence support and outbound calls

Requirements

• High school diploma or GED required
• Associate 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 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
• Must be a WNY candidate
• Immigration or work visa sponsorship will not be provided for this position

Core Competencies

Demonstrates strong customer service capabilities by effectively resolving complaints and providing accurate information on policies and procedures while ensuring compliance with CMS and NCQA standards. Proficient in utilizing multiple systems and maintaining technical knowledge of pharmacy benefits.

Highest-signal resume keywords

• Customer Service Skills
• Call Center Operations Experience
• CMS Compliance Knowledge
• Problem Solving Ability
• Excellent Communication Skills

ATS Optimization Keywords

Hard Skills

• Typing 35-40 Words Per Minute
• Pharmacy Benefit Knowledge
• Regulatory Standards Compliance
• Claims Resolution
• Documentation Skills

Soft Skills

• Organizational Skills
• Time Management Skills
• Listening Skills
• De-escalation Skills
• Written Communication Skills

Industry Keywords

• Health Insurance
• Pharmacy
• NCQA Standards
• CMS Regulations
• Self-Funded Pharmacy Calls

Tools & Technologies

• Multiple System Tools
• Training Manuals