Customer Service Specialist - Remote Work From Home

Healthesystems offers workplace flexibility with our Work-From-Home model, and a competitive compensation and benefits package including healthcare coverage, PTO, paid holidays, 401(k), company-provided life insurance/disability coverage, wellness options, and more.

States preferred: AL, AZ, FL, GA, ID, IN, MD, MS, MO, NC, OH, OK, PA, SC, TN, TX, UT, VA (we are unable to hire in every state)

HOURS: During training: 10:30am-7:15pm, Eastern Time, M-F. After training, regular shifts range between 9am-10pm, Eastern Time, M-F with possible weekends Sat/Sun

WORK FROM HOME REQUIREMENTS: To facilitate working from home, and as a requirement for this role, candidates must provide their own reliable, high speed internet access with sufficient bandwidth to execute all job functions. Additionally, candidates must provide a private workspace free from distraction and noise. Company laptop will be provided.

Summary: The role of the Customer Service Specialist is to build trusted relationships with our clients, their claimants and pharmacies by providing superior customer service to every caller.

Key Responsibilities: “To simplify complexities for each customer.”

- Works with Team Lead, Supervisor and Manager to resolve phone inquiries related to claims adjudication, eligibility verification, prior authorization and other Pharmacy Benefit Management, Ancillary Benefits Management and some Billing Verification Department functions as required. Utilizes strong verbal and written communication, listening and organizational skills as well as strong problem-solving and reasoning skills to accomplish this.

- Demonstrates ability to adhere to attendance, punctuality, and quality guidelines including a flexibility to work varying or rotating shifts, including overtime, weekends, and holidays as necessary.

- Demonstrates ability to read prescription drug names, comprehend simple instructions, and write short correspondence/memos as well as translate jargon and complex processes into simple, step-by-step instructions.

- Demonstrates attention to detail, ability to work in an ever-changing work flow environment, patience, professionalism, and compassion while handling difficult customers and situations. Shows flexibility and a customized approach in meeting all types of member communication styles and personalities. Takes initiative and assumes responsibility where appropriate.

Qualifications/Education/Certifications:

High school diploma or general education degree (GED) and one to two years related customer service and/or healthcare experience required; or equivalent combination of education and experience.
Knowledge, Skills and Abilities:

Knowledge of Windows-based applications as well as the ability to multi-task with dual monitors and swiftly enter information using keyboard is required. Prior experience in an administrative business environment is highly preferred. Experience in the healthcare industry is preferred.
Physical Demands/Working Conditions:

Duties are performed primarily in a home office setting utilizing computer equipment. Travel to attend meetings and visit locations throughout the country may be required. While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is frequently required to use hands. The employee is occasionally required to stand and walk. *** Job descriptions will be reviewed and are subject to changes of business necessity. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

*** Job descriptions will be reviewed and are subject to changes of business necessity. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pay is based on several factors including but not limited to education, work experience, certifications, geographical cost of labor, etc. In addition to base pay, Healthesystems offers a comprehensive