Clinical Member Services Agent
Company: Southern Scripts
Location: Saint Louis
Posted on: November 26, 2022
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
- 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
- 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
- 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
- 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
- Performing Administrative Activities - Performing day-to-day
administrative tasks such as maintaining information files and
- Making Decisions and Solving Problems - Analyzing information
and evaluating results to choose the best solution and solve
- Customer and Client Focus.
- Problem Solving and Analysis.
- Time Management.
- Communication Proficiency.
- Teamwork Orientation.
- Technical Capacity.
- 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
- 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
Keywords: Southern Scripts, St. Louis , Clinical Member Services Agent, Sales , Saint Louis, Missouri
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