Member Services Representative
CurrentAnswering questions while maintaining appropriate etiquette; suggesting features and benefits about company products and services to educate current and potential members; completing all inquiries via various forms of customer contact in a quality manner. Taking member complaints; probing and researching information being provided; following-up with members when appropriate; attempting to resolve difficult situations to ensure member satisfaction; identifying trends that negatively impact member satisfaction. Listening and accurately capturing information and the interaction; completing all necessary paperwork, documentation, member requests and inquiries. Assisting providers in submitting and or completing prior authorization for medications. Faxing forms, relaying information and explaining decisions. Assisting with appeals for denied requests in the same manor. Trouble shooting/ problems solving for pharmacists, as needed, when they cannot get a paid claim for medications. Assisting members get medications, including but not limited to, providing member information, calling pharmacy, understanding time frames, authorization process and laws.