Consumer Services Representative

Company Overview:

Join us in our mission to transform healthcare! RxAdvance, now doing business as nirvanaHealth, is committed to bringing the art of possible to the payer and PBM industries, which is why we strive to invest in our employees throughout all stages of life. Success radiates through all levels of employees here, with competitive benefits, a strong focus on employee wellness, and optional education courses offered through UDEMY: we aim to support all aspects of employee growth.

Characterized by curiosity, innovation, and an entrepreneurial mindset, nirvanaHealth is the first to offer medical and pharmacy benefit management solutions that run on the same platform, made possible by our creation, Aria – the first robotic process automation cloud platform designed for healthcare.

Led by our chairperson John Sculley (former Apple CEO) and noted healthcare entrepreneur and founder of ikaSystems Ravi Ika, nirvanaHealth endeavors to sizably reduce the $900 billion in waste in healthcare administrative and medical costs. We are seeking A-players to join our team – folks who embrace the grind and hustle of a growing company, are collaborative and innovate, are life-long learners and growers, and have an entrepreneurial and positive mindset.

Job Summary :

The Consumer Services Representative is responsible for answering member, pharmacy, and provider inquiries via phone and written communication. They will use problem solving skills and collaboration to resolve the non-clinical questions and/or concerns presented to RxAdvance. The Consumer Services Representative I works in a high-volume call center environment. Part-time and Full-time hours are available.

Job Responsibilities (but not limited to):

• Triage phone calls and written inquiries from members, pharmacy personnel, and providers.• Maintain accurate and complete documentation of all inquiries for continuous improvement.
• Effectively communicate issues and resolutions to members, pharmacy personnel, providers, and appropriate internal staff.
• Follow all internal policies and procedures to ensure consistency, accuracy, and operational effectiveness.
• Use judgment and problem-solving skills to resolve members, pharmacy personnel, and providers concerns.
• Attend and complete required trainings as needed.
• Have a thorough understanding of and perform in compliance with the current PBM v2.2 URAC standards applicable to position.
• Monitor ticketing system and respond to inquiries internal and external to RxAdvance.
• Assist in supplying suggestions and input into training manuals and training documentation.
• Monitor System Dashboard for accuracy and to verify documentation process is followed.
• Assist in peer level training and call observation of new hires.
• Take direction from Consumer Services Leads, Supervisors, Managers, and the VP of Consumer Services.
• Keep up to date with industry trends and regulatory changes in the Health Care industry.
• Understand where to find and how to utilize health insurance benefit details for serviced plans, including but not limited to Commercial, Medicare, and Medicaid payers.
• Intake required information and complete process for Prior Authorization call back requests.
• Complete daily departmental tasks, requirements, and processes as outlined by Consumer Services Manual.
• Attend meetings as required and notifies departmental leadership of meetings (Lead, Supervisor, Manager, and/or VP.)
• Respond to communication from departmental leadership and other stakeholders within the organization in an effective and timely manner.
• Follow all external regulatory, state, federal, and credentialing standards as outlined and/or trained by Compliance.
• Review and respond to work emails in between calls in a timely manner.
• If a complaint is received, fills out the Complaint Form and follows Complaint and Grievance Policy.
• Completes other tasks as assigned by Departmental Leadership (Leads, Supervisors, Managers, and/or VP.)

Qualifications:

Education and/or Training:

• High School Diploma or Equivalent required.
• Associate's or Bachelor's Degree is preferred.

Professional Experience:

• 1-3 years of Customer Service experience required.
• 1-3 years of Call Center or healthcare experience preferred.

Technical Skills:

• Basic level PC skills Required (for example: start up and shut down computer, use mouse to point and click, start, and close programs, switch between programs, save files, print documents and/or access information on-line).
• Basic Search Engines Skills Required, to include opening a browser, typing in URLs in the correct location, using a search engine, bookmarking a site, navigating using back/forward/stop buttons, and filling out forms online.
• Intermediate level keyboarding skills Required (at least 25 WPM, touch typing, formatting documents).
• Communicate effectively in writing and verbally.
• Basic or higher understanding of Microsoft Office preferred.

Additional Considerations:

• Applicants must be able to pass a background investigation as all offers are pending a successful completion of background check per the company policy.