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Clinical Member Services Agent

Company: Southern Scripts
Location: Saint Louis
Posted on: November 26, 2022

Job Description:

Member Services AgentWe wanted a PBM that worked better--- so we created one. Southern Scripts, the leading disruptor in the PBM industry, simplifies the complexities of navigating through the Pharmacy Benefit Manager world by offering a value-added approach to ensure the employer absolute freedom, control, and choice to their health plan structure without compromising patient experiences and outcomes. We improve healthcare and reduce rising prescription costs for employers and their employees. We are looking for individuals who are passionate, strong, and committed to developing systems and service solutions that promote our business goals and commitments.Southern Scripts is searching for incredible talent! We continue to experience accelerated growth in a rapidly changing industry. There's never been a better time to join our team. We are currently seeking a Member Services Agent. This is a remote position.Role and ResponsibilitiesThe clinical member services agent (CMSA) is responsible for providing effective customer service for all internal and external customers by using excellent, in-depth knowledge of company products and programs as well as communicating effectively with team members within the clinical department. The CMSA will work in conjunction with the member service agent to assist in clinical situations and resolutions.

  • Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction. Confer with customers by telephone to provide information about Rx claims processing.
  • Understanding of Pharmacy terms and formularies as a certified Pharmacy Technician (CPhT).
  • Keep detailed records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
  • Follow-up to ensure that appropriate changes were made to resolve customers' problems.
  • Refer unresolved customer grievances to designated departments for further investigation.
  • Review Rx insurance policy terms to determine whether a claim is covered for employer group.
  • Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
  • Resolve customers' service or billing complaints.
  • Obtain and examine all relevant information to assess validity of complaints and to determine possible causes.
  • Abide by all obligations under HIPAA related to Protected Health Information (PHI).
  • If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.
  • Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
  • Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.Required Skills and Competencies
    • Interacting with Computers - Using computers and computer systems (including hardware and software) to enter data or process information.
    • Communicating with Supervisors, Peers, or Subordinates - Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
    • Getting Information - Observing, receiving, and otherwise obtaining information from all relevant sources.
    • Communicating with Persons Outside Organization - Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.
    • Processing Information - Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
    • Resolving Conflicts and Negotiating with Others - Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
    • Updating and Using Relevant Knowledge - Keeping up-to-date technically and applying new knowledge to your job.
    • Organizing, Planning, and Prioritizing Work - Developing specific goals and plans to prioritize, organize, and accomplish your work.
    • Performing Administrative Activities - Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
    • Making Decisions and Solving Problems - Analyzing information and evaluating results to choose the best solution and solve problems.
    • Customer and Client Focus.
    • Problem Solving and Analysis.
    • Time Management.
    • Communication Proficiency.
    • Teamwork Orientation.
    • Technical Capacity.
    • Multitasking
    • Competencies as a Certified Pharmacy Technician (CPhT). Position Type and Expected Hours of WorkThis is a full-time, hourly position. Days and hours of work vary on shift assigned. The Call Center hours of operation are Monday - Friday 6a - 10p, Saturday 8a - 6p, and Sunday 8a-5p. On-Call responsibilities are on a rotation basis.This position reports to the Contact Center Supervisor. TravelMinimal travel expected for this position to Natchitoches, Louisiana for training and development. Qualifications and Education Requirements
      • High School or equivalent.
      • Customer service experience.
      • Certified Pharmacy Technician Certification (CPhT) with experience in a pharmacy setting.
      • Computer experience.Southern Scripts, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Southern Scripts complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Southern Scripts expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Southern Scripts employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/V/D PI197658315

Keywords: Southern Scripts, St. Louis , Clinical Member Services Agent, Sales , Saint Louis, Missouri

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