Assess and render decisions on Special Authorization requests for drug coverage according to established guidelines. Manage correspondence with prescribers and subscribers while handling internal and external inquiries.
The representative responds to telephone inquiries from health care providers regarding benefit eligibility, claim submissions, and plan requirements. They also document call details, analyze workflows, and provide feedback to management to improve processes.
The Customer Service Specialist responds to telephone inquiries regarding benefit plans and government-sponsored health programs. They also educate members on claiming procedures and online tools while maintaining accurate call logs.
The role involves driving market share through consistent sales performance and managing a high volume of inbound and outbound customer calls. You will also collaborate with internal stakeholders to ensure an exceptional customer experience while maintaining accurate administrative records.
The analyst is responsible for assessing and rendering decisions on special authorization requests for drug coverage according to established guidelines. They also manage electronic documentation, perform system entries for claims adjudication, and handle customer inquiries.
