Customer Service Representative - PAR (Premium Healthcare)

• College degree of any 4-year course with at least one (1) year contact center experience.
• Completed at least 2 years in college with 2+ years’ contact center experience.
• Senior High School graduate with 2+ years’ contact center experience.
• Healthcare related call center experience with at least one (1) year prior authorization or pharmacy practices (medical & specialty claims) background is required. 

Mandatory Skills:

• Exceptional customer service, computer, and telephonic skills required.
• Excellent communication skills in the spoken and written word.
• Ability to multi-task in fast-paced environment.
• Ability to handle and resolve escalated issues in a professional manner.
• Ability to adapt and stay motivated in an ever-changing environment.
• Strong decision-making skills to appropriately serve the customer.
• Strong organizational, time-management skills, with ability to prioritize tasks accordingly.
• Computer proficiency with Excel preferred. 

Roles & Responsibilities:

• Responsible for providing high level of service to inbound calls and fax requests 
• Collection of structured clinical data for prior authorization and non-formulary exception requests following the guidance provided in our online prior authorization tools and corresponding forms.
• Initial screening of requests based on guidance given by online prior authorization tools.
• Approves prior authorization requests if the data collected meets the approval specifications.
• Refers prior authorization requests that do not meet the approval specifications to a clinician for review.
• Independently responds to contacts ranging from routine to moderate complexity. May seek assistance with health care professionals for service issues of substantial complexity.
• Performs research to respond to inquiries and interprets policy provisions to determine the most effective response using established departmental procedures, HIPAA regulations, and corporate policies. 
• Must be a champion of change and adapt well to frequent adjustments to procedures or guidance.

The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned.