Customer Care Representative I

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company.

Customer Care Representative I-II

• Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.*

Description

Level I:
Responsible for managing incoming calls, faxes, emails and ePAs related to pharmacy prior authorization. Primary duties may include, but are not limited to:

Manage incoming calls, faxes and ePAs related to pharmacy prior authorizations.

Refers cases requiring clinical review to a Pharmacist or Medical Director.

Responsible for the identification and data entry of pharmacy prior authorization requests.

Analyzes problems and provides information/solutions.

Conducts clinical screening process.

Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.

Thoroughly documents inquiry outcomes for accurate tracking and analysis.

Researches and analyzes data to address operational challenges and customer service issues.

Provides external and internal customers with requested information.

Under immediate supervision, receives and places follow-up telephone calls / e-mails to answer customer questions that are routine in nature.

Uses computerized systems for tracking, information gathering and troubleshooting.

Requires limited knowledge of company services, products, insurance benefits, provider contracts and claims.

Seeks, understands and responds to the needs and expectations of internal and external customers.

Required to meet department goals.

Level II:
Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.

Proficient in all basic customer service areas performs some but not all types of moderately complex function.

Must be able to successfully perform all the duties of the Customer Care Rep I.

Responsible for managing incoming calls, faxes, emails and ePAs related to pharmacy prior authorization. Primary duties may include, but are not limited to:

Manage incoming calls, faxes and ePAs related to pharmacy prior authorizations.

Refers cases requiring clinical review to a Pharmacist or Medical Director.

Responsible for the identification and data entry of pharmacy prior authorization requests.

Analyzes problems and provides information/solutions.

Conducts clinical screening process.

Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner

Analyzes problems and provides information/solutions.

Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.

Thoroughly documents inquiry outcomes for accurate tracking and analysis.

Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Researches and analyzes data to address operational challenges and customer service issues

Provides external and internal customers with requested information.

Proficient in all basic customer service functions.

Receives and places follow-up telephone calls / e-mails to answer customer questions. Inquiries may also be on a walk-in basis.

May require deviation from standard practices and procedures with the assistance of a computerized system.

Requires general knowledge of company services, products, insurance benefits, provider contracts and claims.

Seeks, understands and responds to the needs and expectations of internal and external customers.

Required to meet department goals and expectations.