Representative II

Role Specific Required Qualifications



Role-Specific Experience: Demonstrated success managing high workloads in healthcare call center and/or healthcare-related environments. Familiarity with diverse insurance plans (commercial, Medicare, Medicaid) and pharmacy benefit management processes.

Technical Proficiency: Competence in using the computer and navigating multiple software platforms and systems.



Communication Excellence: Exceptional written and verbal communication skills, including active listening and the ability to convey complex information clearly. Professional and empathetic customer service approach when interacting with healthcare providers and patients.



Analytical & Problem-Solving Skills: Proven ability to assess cases, troubleshoot challenges, and apply critical thinking to determine best outcomes. Precision in data entry to maintain compliance and prevent errors.



Work-From-Home Readiness: Proficiency with remote collaboration tools such as Microsoft Teams, video conferencing platforms, and email and Webcam ready whenever needed. Ability to work independently and manage time effectively in remote environment.



Internet & Tech Requirements

This position requires a dedicated home workspace with a wired ethernet connection (Wi-Fi is not permitted) and reliable internet service of at least 25 mbps download and 5 mbps upload. You must be able to maintain this standard throughout your employment. ***MUST HAVE SCREENSHOT LISTED AT TOP OF RESUME***



Compliance & Confidentiality: Demonstrated adherence to HIPAA regulations and patient privacy protocols.



Attendance & Engagement Commitment: Commitment to adhering to the company s attendance policy and maintaining full engagement throughout the entire scheduled shift, free from personal distractions.



Working hours and Schedule: This position requires schedule availability for an 8 hrs. shift during the operation hours of 7am - 6 pm CST. Maintain 100% attendance throughout the training period. - Training is conducted in CST and lasts exactly 53 days. Candidates must maintain 100% attendance. Post-training schedules will vary based on business needs. NO SCHEDULED TIME OFF IN THE FIRST 53 DAYS OF CONTRACT



This is a fully remote call center position. Candidates can reside anywhere in the U.S. They must have a private home office with a door to ensure HIPAA compliance



•**Completed questions to be listed at top of resume**

At least 2 years of healthcare and /or Health call center experience that includes problem resolution, business writing, quality improvement and customer service. YES OR NO

6 months of working in a virtual role where the supervisor is not physically in the same space. YES OR NO

6 months of PBM/pharmaceutical related work strongly desired. YES OR NO

6 months of High-Volume Call Center strongly required. YES OR NO



Position Summary:



In this role, you will be responsible for:

Training and working virtually.

Utilizing multiple software systems to complete Medicare case.

Meeting or exceeding government mandated timelines.

Complying with turnaround time, productivity and quality standards.

Conveying resolution to beneficiary or provider via direct communication and professional correspondence.

Acquiring and maintaining basic knowledge of relevant and changing Med D guidance.



Duties:



Key Responsibilities

-Ability to work in a fast-paced environment, handling high volume of both inbound and outbound calls and work offline if the business needs.

-Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing.

-Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines.

-Good communication skills are essential, both internal and external.

-Knowledge of Medicare benefits, enrollments and LIS assistance.

-Plans and organizes work assignments, set priorities and completes work with a minimum of supervision.

-Adheres to the service policy and principles of the company, as well as the program guidelines set by the department.

-Participates in cross-training to perform all roles within the department.

-Communicates effectively and professionally with our program partners to assure the best possible service for our patients and partners. Other duties as assigned.



•**Physical Demands: May sit seven (7) to ten (10) hours per day. May be necessary to work extended hours as needed.

-Finger dexterity to operate office equipment required.

-Visual acuity to see and read fine prints.

-Specific vision abilities required by this role include close vision, color vision and the ability to adjust focus.

-Must be able to hear normal voice sounds.

-The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role.



Work Environment: Work from Home Fully Remote.



Experience:



At least 2 years of healthcare and /or Health call center experience that includes problem resolution, business writing, quality improvement and customer service.

6 months of working in a virtual role where the supervisor is not physically in the same space.

6 months of PBM/pharmaceutical related work strongly desired.

6 months of High-Volume Call Center strongly required.



Education:



High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.