Consumer Services Representative

The Consumer Services Representative is responsible for answering member, pharmacy, and provider inquiries via phone and written communication.

They will use problem solving skills and collaboration to resolve the non-clinical questions and/or concerns presented to RxAdvance.

The Consumer Services Representative I works in a high-volume call center environment.

Job Responsibilities (but not limited to):

• Triage phone calls and written inquiries from members, pharmacy personnel, and providers.
• Maintain accurate and complete documentation of all inquiries for continuous improvement.
• Effectively communicate issues and resolutions to members, pharmacy personnel, providers, and appropriate internal staff.
• Follow all internal policies and procedures to ensure consistency, accuracy, and operational effectiveness.
• Use judgment and problem-solving skills to resolve members, pharmacy personnel, and providers concerns.
• Monitor ticketing system and respond to inquiries internal and external to RxAdvance.
• Assist in supplying suggestions and input into training manuals and training documentation.
• Monitor System Dashboard for accuracy and to verify documentation process is followed.
• Assist in peer level training and call observation of new hires.
• Keep up to date with industry trends and regulatory changes in the Health Care industry.
• Understand where to find and how to utilize health insurance benefit details for serviced plans, including but not limited to Commercial, Medicare, and Medicaid payers.
• Intake required information and complete process for Prior Authorization call back requests.
• Follow all external regulatory, state, federal, and credentialing standards as outlined and/or trained by Compliance.
• If a complaint is received, fills out the Complaint Form and follows Complaint and Grievance Policy.

• High School Diploma or Equivalent required.
• Associate's or Bachelor's Degree is preferred.

• 1-3 years of Customer Service experience required.
• 1-3 years of Call Center or healthcare experience preferred.
• Medicare experience strongly preferred.

• Basic level PC skills Required (for example: start up and shut down computer, use mouse to point and click, start, and close programs, switch between programs, save files, print documents and/or access information on-line).
• Basic Search Engines Skills Required, to include opening a browser, typing in URLs in the correct location, using a search engine, bookmarking a site, navigating using back/forward/stop buttons, and filling out forms online.
• Intermediate level keyboarding skills Required (at least 25 WPM, touch typing, formatting documents).
• Communicate effectively in writing and verbally.
• Basic or higher understanding of Microsoft Office preferred.