Customer Service Representative

2 weeks ago

Pittsburgh, Pennsylvania, United States SSi People Full time
Job Title: Benefit Investigation Specialist/ Customer Service Representative/ Data Entry

Location: Remote (M-F)

Duration: 4+ months contract on W2 with possibility to full time/ Extension

Client: Hospitals and Healthcare

Job Description:

We are seeking a highly skilled and detail-oriented Benefits Investigation Specialist/ Customer Service Representative/ Data Entry to join our team at SSi People. As a key member of our team, you will be responsible for direct contact with Medical Insurance Payers and Pharmacy Benefit Managers to identify and document available coverage options for retail and specialty medications.

Key Responsibilities:
  • Makes outbound calls to Payers and Pharmacy Benefit Managers to verify patient insurance coverage and identify available Medical and Pharmacy benefits
  • Communicates case details to appropriate internal or external parties once benefit verification is complete
  • Identifies any payer coverage restrictions and potential mechanisms for quickly accessing therapy
  • Effectively contributes alone or in small work groups
  • Meets production and time completion goals
  • Accurately documents payer Prior Authorization and Appeals protocols
  • Participates in special projects and performs additional duties as required
  • Maintains a repository of payer or brand-specific coverage information
  • Participates in training and process improvement initiatives
Requirements:
  • Minimum of 2 years' experience in customer service, insurance, benefits, marketing, sales, or related area, required, or Bachelor's degree and 1 year of relevant experience
  • Healthcare environment with third-party benefits verification experience preferred
  • Understanding of commercial insurance concepts, including coverage policies, major medical benefits, knowledge of government and patient assistance programs, knowledge of and understanding of how to communicate information on health insurance, reimbursements, third-party terms, and medical terminology is preferred
  • Ability to write routine reports and correspondence using computer applications. Excellent verbal skills and knowledge of medical terms
  • Ability to work efficiently in Microsoft Office, including the creation of spreadsheets in Excel and the ability to take notes via computer keyboard during telephone conversations
  • Skill in managing email correspondence and personal documentation of research
  • Focus on fundamental analytic and problem-solving skills
  • Excellent time management skills
  • Strong professional customer services experience
  • High level of attention to detail
  • Be a critical thinker who is adaptable and results-driven
Education:
  • High school diploma or equivalent, required. Bachelor's degree preferred
Required Skills:
  • Benefits/health insurance
  • Outbound calls
  • Medical terminology
  • Customer service

Languages: English (Speak, Read, Write)

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