Customer Service Representative I

Job Title: Customer Service Representative I

Company: MedImpact Healthcare Systems, Inc.

About the Role

MedImpact Healthcare Systems, Inc. is seeking dedicated professionals to join their team. The company delivers pharmaceutical and technology solutions to improve healthcare value, aiming to optimize satisfaction, service, cost, and quality in the healthcare industry.

Summary Job Description

Provides outstanding customer service to pharmacies, physicians, health plan sponsors, and their members, beneficiaries, or employees. Responds to and resolves phone inquiries related to benefit information, claims adjudication, eligibility verification, prior authorization, and other PBM processes. Works under general supervision, utilizing instructions, work process guidelines, policies, procedures, and company knowledge.

Essential Duties and Responsibilities

• Convey a positive company image by promptly responding to customer phone inquiries and resolving issues, gathering/providing information, and offering assistance.
• Deliver service meeting or exceeding department performance standards for Average Hold Time, Abandonment Rate, Talk Time, Quality, Adherence, and One-touch Resolution.
• Utilize multiple company database programs and Salesforce.com to research and resolve complex issues.
• Use task routing functions and other applicable processes to escalate issues or request assistance.
• Educate external customers about MedImpact's roles and responsibilities, including override guidelines, benefit plan restrictions, prior authorization requirements, and grievance/appeal processes.
• Follow up with callers to ensure customer satisfaction and timely response.
• Diffuse irate or upset customers by listening, calming them, and providing positive solutions.
• Represent MedImpact positively by adhering to processes, established procedures, and guidelines.
• Support department strategy through customer service excellence, including telephone courtesy, prompt response, anticipating customer needs, solution-oriented problem solving, and adherence to scripts.
• Identify opportunities and recommend improvements for workflow processes, operating systems, training programs, reference materials, and quality initiatives.
• Stay current on new plan information by attending staff meetings and company-required training.
• Pharmacy Technician Certified CSRs support physician calls and can review Prior Authorization (PA) guidelines in the MedAccess system.
• Be available to answer calls during periods of high volume.
• Serve as a resource to the Customer Service team.

Requirements & Tech Stack

• MS Office/Word, Excel, and Outlook (Intermediate knowledge)
• Aptitude for new programs
• Experience with Windows-based database programs

Qualifications

• GED/HS Diploma and 6+ months’ experience or equivalent combination of education and experience.
• Demonstrated ability to appear for work on time, follow directions, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals, and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.
• Demonstrated ability to meet or exceed listed competencies.

Reasoning Ability

• Apply common sense understanding to carry out detailed instructions; deal with problems involving a few concrete variables in standardized situations.
• Solve practical problems and deal with a variety of concrete variables in situations with limited standardization.

Mathematical Skills

• Add, subtract, multiply, and divide using whole numbers, common fractions, and decimals.
• Compute rate, ratio, and percent; draw and interpret bar graphs.

Language Skills

• Read and comprehend simple instructions, short correspondence, and memos.
• Write simple correspondence.
• Effectively present information in one-on-one and small group situations to customers, clients, and other employees.

Competencies

• Composure
• Decision Quality
• Organizational Agility
• Problem Solving
• Customer Focus
• Drive for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Political Savvy

Work Environment

This position may regularly be exposed to or encounter moving mechanical parts, high/precarious places, fumes/airborne particles, toxic/caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level is usually moderate.

Work Location

This position requires on-site work at the San Diego Headquarters or Tempe office location. Remote work is not an option.

Working Hours

This is a full-time non-exempt position requiring availability for overtime as needed, including nights, weekends, or holidays. Typical hours are Monday through Friday, 8:00 am to 5:00 pm.

Travel

No travel is required, however, attendance at various local conferences and meetings may be required.

Perks

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus