Servicing Representative

Independent Health; Buffalo (NY); On-site; USD 23,000 - 32,000; Full time

Benefits offered by this job

Health benefits

Job summary

Independent Health is seeking a Servicing Representative in Buffalo, NY to advocate for customers and resolve inquiries related to Pharmacy Benefit Dimensions. You will communicate benefit details, answers to claims, eligibility, and reimbursements, using multiple systems while maintaining compliance.

Required is a high school diploma or GED (associates preferred) and 6 months in health insurance or pharmacy-related work, with strong communication and call-center experience.

Qualifications

• High school diploma or GED required; associates degree preferred.
• Six months of health insurance or pharmacy-related experience preferred.
• Experience in a call center environment is a plus.
• Strong written and verbal communication skills are essential.
• Ability to handle high-volume calls and prioritize tasks.

Responsibilities

• Act as a customer advocate by delivering excellent service via phone, email, mail, and in person.
• Provide accurate policy, benefit, eligibility, and reimbursement information.
• Log contacts into appropriate systems and ensure regulatory compliance.
• Keep knowledge updated on CMS rules and PBD contracts; assist with appeals.
• Meet department standards for quality, productivity, and accuracy.

Skills

Communication skills

Typing 35-40 wpm

Active listening

Multitasking in systems

Call center experience

Time management

Problem solving

Education

High school diploma or GED

Associates degree preferred

Tools

CRM 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.

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 / Affiliation of an Equal Opportunity / ... Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub.