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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in customer service within the healthcare industry, with a strong focus on insurance claims, billing, and coding processes. Proficient in managing multiple priorities while maintaining high-quality communication and problem-solving skills.
Highest-signal resume keywords
Customer Service ExperienceHealth Insurance ClaimsBilling And Coding KnowledgeExcellent Communication SkillsProblem Solving Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Customer ServiceInsurance Benefit VerificationPrior AuthorizationMedical TerminologyThird-Party BillingData EntryCall Center OperationsPatient AccountingAnalytical SkillsDocumentation Management
Soft Skills
Detail OrientedPatienceAdaptabilityCollaborationProfessionalism
Tools & Technologies
MS Office ApplicationsDatabase Management
Industry Keywords
PBMHealthcare IndustryFDA RequirementsReimbursement InquiriesCall Triage
About the role
Key responsibilities & impact- Provide the highest quality of customer service to patients and client representatives
- Acquire in-depth knowledge of client and marketing requirements
- Complete verification of benefits and eligibility for referrals from patients, medical doctor’s offices, health plans and pharmaceutical manufacturers
- Review incoming referrals for completeness and confirm FDA requirements are met as applicable
- Answer incoming calls quickly and efficiently, evaluate needs, and respond or route calls to the appropriate team member
- Assist with reimbursement inquiries, including insurance benefit verification, prior authorization, denials, appeals, and other reimbursement issues
- Provide billing and coding information related to specific products when applicable
- Conduct general payer research
- Participate in call center activities and triage incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies
- Serve as a single point of contact for an assigned group of prescribers when applicable
- Manage action item lists and ensure tasks are completed in a timely manner
- Maintain accurate and complete documentation of inquiries
- Identify and escalate repetitive questions or problems for corrective action
- Maintain good housekeeping techniques and adhere to quality, production, safety, and environmental standards
- Perform other duties as assigned
Requirements
What you’ll need- High School diploma or equivalent
- 3-5 years’ experience in a customer service setting, preferably in a call center environment
- Previous experience in the PBM and or Healthcare Industry preferred
- Computer proficiency in MS Office applications, with database experience preferred
- Health insurance claims or patient accounting experience preferred
- Knowledge of third-party billing, coding, medical terminology, prior authorizations and appeals preferred
- Detail oriented with good analytical skills
- Ability to manage multiple priorities and meet deadlines
- Excellent written and verbal communication skills, demonstrated ability to communicate with others at all levels
- Excellent customer skills-patience to explain details and processes repeatedly, excellent phone presentation skills
- Demonstrated ability to handle challenging customers in a professional manner, ability to adapt in a dynamic work environment and make decisions with minimal supervision
- Advance problem solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions
- Ability to work a flexible schedule
Benefits
Comp & perks- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match
- Tuition reimbursement
- Flexible work environment
- 20 days PTO, accrued
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine(Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs