Remote Healthcare Customer Service Representative - Prescription Benefit Support Specialist

Transforming Healthcare through Exceptional Customer Service TEKsystems, a leading industry partner in Full-Stack Technology Services and Talent Services, is seeking a highly skilled and compassionate Remote Healthcare Customer Service Representative to join our team. As a Customer Care Specialist, you will play a vital role in delivering top-notch support to members regarding their prescription benefits, ensuring they receive the care and guidance they need. About Our Client and the Role Our client is a prominent player in the healthcare industry, providing prescription benefit management services to numerous organizations. As a Remote Healthcare Customer Service Representative, you will be the primary point of contact for members seeking assistance with their prescription benefits. Your expertise and empathy will be instrumental in resolving queries, addressing concerns, and providing personalized support to ensure a seamless experience. Key Responsibilities Handle incoming calls from members regarding questions about their prescription benefits, including copays, medication coverage, and prior authorization processes. Understand, apply, and communicate client-specific prescription benefit and pharmacy claim processing information to members, including formularies, clinical programs, and appeal rights. Educate members on how to best utilize their benefits, troubleshoot pharmacy claims in real-time, and provide superior service through outbound calls as necessary. Send documents to providers electronically and maintain accurate records. Anticipate and address questions to prevent repeat calls, delight customers, and reduce customer effort. Treat all customers with respect, empathy, and professionalism, ensuring confidentiality and adherence to HIPAA regulations. Deliver relevant information in a timely and clear manner, utilizing resources consistently to incorporate changes in our fast-paced environment. Adapt to fluctuations in workload, demonstrating flexibility and a positive attitude. Effectively collaborate with internal teams, including other Customer Care team members, Prior Authorization, and Manual Claims. Maintain scheduled hours and demonstrate reliability, consistency, and a professional demeanor at all times. Essential Qualifications and Skills To excel in this role, you will need: 2 years of prior medical customer service experience, preferably in a prescription benefit or healthcare-related environment. Excellent phone etiquette and typing skills (40wpm, 500kph), with the ability to navigate systems efficiently while speaking. Basic knowledge of Microsoft Office and internet applications, with the ability to review documents related to pharmacy benefits. Exceptional oral and written communication skills, with the ability to hear needs and translate them into correct resolution steps. Ability to balance quality with speed, identify root causes of problems, and use resources to solve problems independently. Reliability, including maintaining your schedule, consistently positive attitude, and professional behavior at all times. Preferred Qualifications While not mandatory, the following qualifications will be considered a plus: Experience working in a fast-paced, dynamic environment with a high volume of customer inquiries. Familiarity with prescription benefit management systems and processes. Knowledge of HIPAA regulations and confidentiality requirements. Career Growth Opportunities and Learning Benefits At TEKsystems, we are committed to your growth and development. As a Remote Healthcare Customer Service Representative, you will have access to: Ongoing training and support to enhance your skills and knowledge in prescription benefit management and customer service. Opportunities for career advancement within our organization, with a clear path for professional growth. A collaborative and dynamic work environment that fosters innovation and teamwork. Work Environment and Company Culture As a remote employee, you will enjoy the flexibility and autonomy to work from the comfort of your own space. Our company culture is built on a foundation of: Innovation : We encourage creativity and out-of-the-box thinking to drive results. Teamwork : We believe in the power of collaboration and mutual support. Diversity and Inclusion : We celebrate our differences and strive to create an inclusive environment for all. Compensation, Perks, and Benefits We offer a competitive compensation package, including a range of benefits and perks designed to support your well-being and success. While specific details may vary, our benefits typically include: Comprehensive health insurance Retirement savings plans Paid time off and holidays Professional development opportunities Access to cutting-edge technology and tools Join Our Team and Make a Difference If you are a compassionate and skilled customer service professional looking to make a meaningful impact in the healthcare industry, we encourage you to apply for this exciting opportunity. As a Remote Healthcare Customer Service Representative at TEKsystems, you will be part of a dynamic team dedicated to delivering exceptional support to members and driving positive change in the healthcare landscape. TEKsystems is an equal opportunity employer, committed to diversity and inclusion in the workplace. We welcome applications from qualified candidates without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information, or any characteristic protected by law. Don't miss this chance to join our team and transform the healthcare experience for members. Apply now and take the first step towards a rewarding and challenging career in healthcare customer service! Apply for this job