CommunityCare

Provide technical and customer service support for pharmacy benefits including processing prior authorizations and resolving pharmacy-related complaints via telephone. | High school diploma, two years of managed care pharmacy benefits or related experience, one year customer service experience, strong communication skills, proficiency in Microsoft applications, confidentiality, and ability to work under pressure. | JOB SUMMARY: Responsible for providing technical and customer service support for pharmacy benefits, processing prior authorizations according to CMS and State regulations, and resolving pharmacy related complaints. KEY RESPONSIBILITIES: Telephone support for pharmacies and members related to pharmacy benefits for the HMO product. Provides resolution for various types of phone calls including, but not limited to referral, authorization, and step therapy protocols between physicians, pharmacies and members for the HMO product. Resolve claims adjudication issues related to pharmacy. Responsible for processing prior authorizations for medications. Work may require overtime to meet deadlines. Work may also involve dealing with members who are disgruntled or upset. Performs other duties as assigned. QUALIFICATIONS: Basic punctuation and grammar skills Ability to function under pressure. Proficient in Microsoft applications. Ability to work independently and apply good judgment. Ability to maintain and preserve information of highly confidential nature. Possess strong oral and written communication skills. Capable of project management from beginning to completion. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: High school diploma or equivalent. Two years’ experience in managed care pharmacy benefits, pharmacy tech or related discipline. Basic understanding of Health Plan Industry. One year customer service experience required. Previous customer service experience in a Medicare Advantage plan preferred. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Provide technical and customer service support for pharmacy benefits, focusing on prior authorizations and complaint resolution via telephone. | High school diploma, two years in managed care pharmacy benefits or related field, one year customer service, strong communication and Microsoft skills. | JOB SUMMARY: Responsible for providing technical and customer service support for pharmacy benefits, processing prior authorizations according to CMS and State regulations, and resolving pharmacy related complaints. KEY RESPONSIBILITIES: Telephone support for pharmacies and members related to pharmacy benefits for the HMO product. Provides resolution for various types of phone calls including, but not limited to referral, authorization, and step therapy protocols between physicians, pharmacies and members for the HMO product. Resolve claims adjudication issues related to pharmacy. Responsible for processing prior authorizations for medications. Work may require overtime to meet deadlines. Work may also involve dealing with members who are disgruntled or upset. Performs other duties as assigned. QUALIFICATIONS: Basic punctuation and grammar skills Ability to function under pressure. Proficient in Microsoft applications. Ability to work independently and apply good judgment. Ability to maintain and preserve information of highly confidential nature. Possess strong oral and written communication skills. Capable of project management from beginning to completion. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: High school diploma or equivalent. Two years’ experience in managed care pharmacy benefits, pharmacy tech or related discipline. Basic understanding of Health Plan Industry. One year customer service experience required. Previous customer service experience in a Medicare Advantage plan preferred. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Lead and support a customer service team to resolve complex issues and improve team performance. | Requires 3-5 years customer service experience in call center or healthcare, supervisory experience preferred, strong communication and organizational skills. | JOB SUMMARY: Responsible for providing daily guidance, instruction, and training to inspire the team to perform at their optimum. In addition, they will provide support to Customer Service Representatives by being a subject matter expert. Will work directly with the Customer Service Manager to create a team that works efficiently together to maximize the team's potential. Also responsible for interacting with members, providers, and other internal customers to resolve elevated problems of a complex nature. May serve as a liaison between Customer Service and other departments. Assists the Customer Service Supervisor(s) with monitoring daily queue activity to make staffing adjustment suggestions as needed. Focus on helping the team build necessary skills and knowledge so they can better support customers and the company's mission. The successful team leader should be supportive, communicative, and attentive. Should be well-spoken with a professional demeanor and professional phone presence as well as excellent interpersonal skills. KEY RESPONSIBILITIES: • Effectively manage escalated phone calls of the most complex nature involving multiple lines of business utilizing problem resolution skills. • Prepare Customer Service Representatives to respond to customer questions and complaints and to troubleshoot problems with services or products. • Assist supervisor with communicating regularly to employees any changes that have direct impact on inquiry responses. • Assist walk-in members with inquiries. • Ability to adapt and assist associates with organizational changes including business processes, systems, and technology. • Assists in actively managing the day-to-day activities of the team by monitoring call queues and wait times and directing resources as needed. • Works closely with supervisors to empower team members to improve their confidence, product knowledge and communication skills. • Motivate the team to achieve organizational goals that contributes to the growth of the company. • Identify training needs and conduct training of team members as needed to maximize potential. • Contribute to the creation of a pleasant working environment that serves to inspire the team. • Assist Customer Service Manager and Supervisors by performing additional duties where needed or as directed. • Answer incoming questions or provide guidance through multiple mediums to internal employees regarding procedure, product, processes, memberships displaying extensive product knowledge. • Maintains compliance with policies and procedures and ensures that CSRs adhere in resolving customer concerns. • Accountable for monitoring multiple queues, email boxes, and fax lines to ensure work is completed. • Performs other job related duties as assigned. QUALIFICATIONS: • Proficient knowledge of customer service, and standard office practices and procedures. • Possess strong oral and written communication skills. • Confidence and skillful negotiating skills • Ability to motivate employees and provide feedback that assists in evaluating performance. • Strong relationship building skills for motivating and inspiring team. • Proficient in Microsoft applications. • Strong organizational and time management skills with attention to detail • Bilingual a plus. • Successful completion of Health Care Sanctions background check. • Available to work all shifts as needed. • Demonstrated ability in customer service problem resolution. EDUCATION/EXPERIENCE: • High School diploma or equivalent; bachelor's degree preferred. • Three to five years of previous customer service experience preferably in a call center or healthcare environment. • Supervisory experience preferred. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Provide daily guidance, training, and subject matter expertise to customer service representatives while resolving complex issues and assisting supervisors with monitoring. | Requires 3-5 years customer service experience, preferably in call center or healthcare, strong communication and negotiation skills, and a high school diploma or bachelor's degree preferred. | JOB SUMMARY: Responsible for providing daily guidance, instruction, and training to inspire the team to perform at their optimum. In addition, they will provide support to Customer Service Representatives by being a subject matter expert. Will work directly with the Customer Service Manager to create a team that works efficiently together to maximize the team’s potential. Also responsible for interacting with members, providers, and other internal customers to resolve elevated problems of a complex nature. May serve as a liaison between Customer Service and other departments. Assists the Customer Service Supervisor(s) with monitoring daily queue activity to make staffing adjustment suggestions as needed. Focus on helping the team build necessary skills and knowledge so they can better support customers and the company’s mission. The successful team leader should be supportive, communicative, and attentive. Should be well-spoken with a professional demeanor and professional phone presence as well as excellent interpersonal skills. KEY RESPONSIBILITIES: Effectively manage escalated phone calls of the most complex nature involving multiple lines of business utilizing problem resolution skills. Prepare Customer Service Representatives to respond to customer questions and complaints and to troubleshoot problems with services or products. Assist supervisor with communicating regularly to employees any changes that have direct impact on inquiry responses. Assist walk-in members with inquiries. Ability to adapt and assist associates with organizational changes including business processes, systems, and technology. Assists in actively managing the day-to-day activities of the team by monitoring call queues and wait times and directing resources as needed. Works closely with supervisors to empower team members to improve their confidence, product knowledge and communication skills. Motivate the team to achieve organizational goals that contributes to the growth of the company. Identify training needs and conduct training of team members as needed to maximize potential. Contribute to the creation of a pleasant working environment that serves to inspire the team. Assist Customer Service Manager and Supervisors by performing additional duties where needed or as directed. Answer incoming questions or provide guidance through multiple mediums to internal employees regarding procedure, product, processes, memberships displaying extensive product knowledge. Maintains compliance with policies and procedures and ensures that CSRs adhere in resolving customer concerns. Accountable for monitoring multiple queues, email boxes, and fax lines to ensure work is completed. Performs other job related duties as assigned. QUALIFICATIONS: Proficient knowledge of customer service, and standard office practices and procedures. Possess strong oral and written communication skills. Confidence and skillful negotiating skills Ability to motivate employees and provide feedback that assists in evaluating performance. Strong relationship building skills for motivating and inspiring team. Proficient in Microsoft applications. Strong organizational and time management skills with attention to detail Bilingual a plus. Successful completion of Health Care Sanctions background check. Available to work all shifts as needed. Demonstrated ability in customer service problem resolution. EDUCATION/EXPERIENCE: High School diploma or equivalent; bachelor’s degree preferred. Three to five years of previous customer service experience preferably in a call center or healthcare environment. Supervisory experience preferred. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Serve as the initial contact for membership inquiries and resolve customer issues professionally with a focus on benefits and eligibility questions. | Requires high school diploma and at least one year of direct customer service experience with proficiency in Microsoft Office. | JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will be customer focused, detail oriented and results driven. The most successful Customer Service Representatives demonstrate the following characteristics: polite, accurate, knowledgeable, able to work well within a team, learning agility, flexible and easily adapts to change. KEY RESPONSIBILITIES: Process a high volume of incoming inquiries regarding multiple products from members, providers, billing companies, individuals with legal representation, employer groups, and other insurance companies. Strive to achieve first call resolution by communicating accurate information efficiently and timely thereby creating a positive experience for the member. Verifies eligibility, benefits, deductible amounts, claim status, copays, coinsurance and all other information related to a customer and their benefits or a provider and their contract. Use effective listening skills to understand the needs and complaints of the customer to offer them the best possible solution and ensuring the member feels supported and valued. Resolve escalated customer issues received from the member, provider, employer groups or brokers while remaining calm and professional. Provide interpretation services for all product lines via the contracted language line service as appropriate. Flexible hours, including weekends and evenings, as department or training needs dictate and at the discretion of management may be required. Effective problem resolution skills that demonstrates balance of company and customer needs. Demonstrated ability and learning agility to adapt to organizational changes including business processes, systems and technology. Joining a team of Customer Service Representatives and building a positive relationship of teamwork, trust, reliability and excellence. Understanding and striving to meet or exceed call center metrics while providing excellent customer service. Taking part in training and other learning opportunities to expand knowledge of company and position. Perform other duties as assigned. QUALIFICATIONS: Exceptional telephone manner, customer service skills, active listening skills, verbal and written communication skills. Ability to resolve conflict and diffuse tension Strong time management skills and decision- making skills. Ability to read, comprehend, and explain health insurance benefits in a clear, concise, and professional manner. Ability to work under stress with production and quality standards. Proficient in Microsoft Office applications. Highly organized and attentive to detail. Flexibility, ability to adapt to change. Successful completion of Health Care Sanctions background check. Bilingual skills a plus. EDUCATION/EXPERIENCE: High school diploma or equivalent required 1-year customer service experience with direct interactions with customers Contact center or medical field experience preferred CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Serve as the initial contact for membership inquiries, providing outstanding customer service and resolving issues related to benefits and claims. | Strong telephone manner, customer service skills, active listening, conflict resolution, time management, decision-making, and proficiency in Microsoft Office. | JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will be customer focused, detail oriented and results driven. The most successful Customer Service Representatives demonstrate the following characteristics: polite, accurate, knowledgeable, able to work well within a team, learning agility, flexible and easily adapts to change. KEY RESPONSIBILITIES: Process a high volume of incoming inquiries regarding multiple products from members, providers, billing companies, individuals with legal representation, employer groups, and other insurance companies. Strive to achieve first call resolution by communicating accurate information efficiently and timely thereby creating a positive experience for the member. Verifies eligibility, benefits, deductible amounts, claim status, copays, coinsurance and all other information related to a customer and their benefits or a provider and their contract. Use effective listening skills to understand the needs and complaints of the customer to offer them the best possible solution and ensuring the member feels supported and valued. Resolve escalated customer issues received from the member, provider, employer groups or brokers while remaining calm and professional. Provide interpretation services for all product lines via the contracted language line service as appropriate. Flexible hours, including weekends and evenings, as department or training needs dictate and at the discretion of management may be required. Effective problem resolution skills that demonstrates balance of company and customer needs. Demonstrated ability and learning agility to adapt to organizational changes including business processes, systems and technology. Joining a team of Customer Service Representatives and building a positive relationship of teamwork, trust, reliability and excellence. Understanding and striving to meet or exceed call center metrics while providing excellent customer service. Taking part in training and other learning opportunities to expand knowledge of company and position. Perform other duties as assigned. QUALIFICATIONS: Exceptional telephone manner, customer service skills, active listening skills, verbal and written communication skills. Ability to resolve conflict and diffuse tension Strong time management skills and decision- making skills. Ability to read, comprehend, and explain health insurance benefits in a clear, concise, and professional manner. Ability to work under stress with production and quality standards. Proficient in Microsoft Office applications. Highly organized and attentive to detail. Flexibility, ability to adapt to change. Successful completion of Health Care Sanctions background check. Bilingual skills a plus. EDUCATION/EXPERIENCE: High school diploma or equivalent required 1-year customer service experience with direct interactions with customers Contact center or medical field experience preferred CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Lead and support a customer service team, manage escalated calls, and assist with training and operational tasks. | Requires 3-5 years customer service experience, supervisory experience preferred, strong communication and organizational skills, and ability to manage complex customer issues. | JOB SUMMARY: Responsible for providing daily guidance, instruction, and training to inspire the team to perform at their optimum. In addition, they will provide support to Customer Service Representatives by being a subject matter expert. Will work directly with the Customer Service Manager to create a team that works efficiently together to maximize the team's potential. Also responsible for interacting with members, providers, and other internal customers to resolve elevated problems of a complex nature. May serve as a liaison between Customer Service and other departments. Assists the Customer Service Supervisor(s) with monitoring daily queue activity to make staffing adjustment suggestions as needed. Focus on helping the team build necessary skills and knowledge so they can better support customers and the company's mission. The successful team leader should be supportive, communicative, and attentive. Should be well-spoken with a professional demeanor and professional phone presence as well as excellent interpersonal skills. KEY RESPONSIBILITIES: • Effectively manage escalated phone calls of the most complex nature involving multiple lines of business utilizing problem resolution skills. • Prepare Customer Service Representatives to respond to customer questions and complaints and to troubleshoot problems with services or products. • Assist supervisor with communicating regularly to employees any changes that have direct impact on inquiry responses. • Assist walk-in members with inquiries. • Ability to adapt and assist associates with organizational changes including business processes, systems, and technology. • Assists in actively managing the day-to-day activities of the team by monitoring call queues and wait times and directing resources as needed. • Works closely with supervisors to empower team members to improve their confidence, product knowledge and communication skills. • Motivate the team to achieve organizational goals that contributes to the growth of the company. • Identify training needs and conduct training of team members as needed to maximize potential. • Contribute to the creation of a pleasant working environment that serves to inspire the team. • Assist Customer Service Manager and Supervisors by performing additional duties where needed or as directed. • Answer incoming questions or provide guidance through multiple mediums to internal employees regarding procedure, product, processes, memberships displaying extensive product knowledge. • Maintains compliance with policies and procedures and ensures that CSRs adhere in resolving customer concerns. • Accountable for monitoring multiple queues, email boxes, and fax lines to ensure work is completed. • Performs other job related duties as assigned. QUALIFICATIONS: • Proficient knowledge of customer service, and standard office practices and procedures. • Possess strong oral and written communication skills. • Confidence and skillful negotiating skills • Ability to motivate employees and provide feedback that assists in evaluating performance. • Strong relationship building skills for motivating and inspiring team. • Proficient in Microsoft applications. • Strong organizational and time management skills with attention to detail • Bilingual a plus. • Successful completion of Health Care Sanctions background check. • Available to work all shifts as needed. • Demonstrated ability in customer service problem resolution. EDUCATION/EXPERIENCE: • High School diploma or equivalent; bachelor's degree preferred. • Three to five years of previous customer service experience preferably in a call center or healthcare environment. • Supervisory experience preferred. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin