XTN-9794954 | CUSTOMER SERVICE REPRESENTATIVE I

MedImpact was established over three decades ago by a pharmacist and independent drug store owner who witnessed the struggles families faced with high prescription costs. Committed to making prescription benefits more accessible and understandable, MedImpact has since grown into one of America's leading PBMs while staying true to its founding principles.

• Health Insurance/HMO
• Enjoy unlimited MadMax Coffee
• Diverse learning & growth opportunities
• Accessible Cloud HR platform (Sprout)
• Above standard leaves
  
  
  

The Customer Support Representative I provides exceptional customer service to pharmacies, physicians, health plan sponsors, and their members, beneficiaries, or employees. It involves promptly responding to and effectively resolving phone inquiries concerning benefit information, claims adjudication, eligibility verification, prior authorization, and other pharmacy benefit management (PBM) processes. The position operates under general supervision, following instructions, work process guidelines, policies & procedures, and leveraging company knowledge/experience to fulfill job duties. Supervision levels vary from close to moderate depending on demonstrated skill and performance levels outlined for the role. Additionally, this position is part of a two-level career path with progression opportunities detailed in the Core Service Career Path/Succession Planning Guidelines.

• Convey a positive image of the company by promptly responding to customer phone inquiries and determining the appropriate actions to resolve issues, gather and provide information, and offer assistance.
• Deliver service that meets or exceeds department performance standards for Average Hold Time, Abandonment Rate, Talk Time, Quality, Adherence, and One-touch Resolution.
• Utilize multiple company database programs to research and resolve complex issues relating to benefit information, claims adjudication, eligibility verification, prior authorization, and other PBM processes. Use task route function, SalesForce.com, and other processes & tools as applicable to escalate issues, request follow up action, or obtain assistance from other areas of the organization as necessary.
• Educate external customers about MedImpact’s roles and responsibilities. Provide information about override guidelines, benefit plan restrictions, prior authorization requirements, grievance and appeal processes, and other PBM functions as specified by health plan sponsors in online CS Notes.
• Follow up with callers as appropriate to ensure customer satisfaction and timely response to requests. Diffuse irate or emotionally upset customers by appropriately listening to issues, calming the customer, and providing positive solutions to resolve concerns.\
• Represent MedImpact in a positive manner by adhering to SMART processes and established procedures and guidelines. Support the department strategy by delivering Customer Service
• Excellence through telephone courtesy, prompt response to callers, anticipation of customer needs and concerns, solution-oriented problem solving, and adherence to call center scripts, greetings, and call closing messages.
• Identify opportunities and make recommendations to department leadership for improvement of workflow processes, operating systems, training programs, reference materials, and quality initiatives that enhance the customer experience.
• Keep current on new plan information and instructions by attending and participating in staff meetings, RTL’s, company-required training programs, and other activities that develop skills, build teamwork, and provide updated information.
• Pharmacy Technician Certified CSR’s support physician calls and can review Prior Authorization (PA) guidelines noted in the MedAccess system.
• Customer and Quality Focus: Actively understands and addresses client needs, ensures high-quality products and services, maintains high customer satisfaction, and contributes to continuous improvement of products and processes.
• Interpersonal Effectiveness: Demonstrates strong people skills by committing to teamwork, resolving conflicts respectfully, valuing differences, and building strong relationships and networks.
• Communication: Clearly and effectively communicates in face-to-face interactions, presentations, and written documents. Uses active listening skills to ensure productive interactions.
• Business Knowledge: Possesses a clear understanding of the business, including its products, services, goals, market, competitors, and challenges.
• Teamwork: Engages in collaborative decision-making and problem-solving, positively contributes as a team member, shares credit appropriately, and encourages teammates to utilize their skills and knowledge.
• Reliability: Maintains a good attendance and punctuality record, follows through on actions with minimal supervision, and fulfills commitments.
• Professionalism: Acts with integrity, demonstrates reliability and responsibility, displays emotional intelligence, and complies with relevant laws, policies, and procedures.
• Quality Focus: Personally invests in ensuring the quality of products and services, going the extra mile to meet or exceed standards.
• Problem Solving: Analyzes problems logically, identifies root causes, seeks diverse input, asks insightful questions, and formulates effective solutions.
• Organization: Effectively organizes resources, information, and workspace to ensure an efficient and effective work process.
• Initiative: Proactively gathers and analyzes information, assesses situations, identifies challenges and opportunities, and takes appropriate action.
• Adaptability: Adjusts quickly to changing situations, integrates new information, remains flexible, implements necessary changes, and leverages new opportunities.
  
  
  

Physical Demands

The physical demands for this job include:

• Regularly: Sitting and talking or hearing.
• Frequently: Using hands to finger, handle, or feel, and reaching with hands and arms.
• Occasionally: Standing, walking, stooping, kneeling, crouching, or crawling.
• Lifting: Occasionally lifting and/or moving up to 10 pounds.
• Vision: Requires close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
  
  
  

Working Environment

The work environment characteristics include:

• Setting: Office setting.
• Noise Level: Moderate noise (e.g., business office with computers and printers, light traffic).
  
  
  

Working Hours

• Schedule: Non-exempt position requiring potential overtime. Must be able to work nights, weekends, and/or holidays as needed. The Contact Center operates 24 hours a day, every day of the year, with shifts varying based on business needs.
  
  
  

Travel

• Requirements: No travel required, but attendance at local training sessions and/or meetings may be necessary.
• Healthcare or Pharmacy Benefit Management Experience