Customer Care Associate - Pharmacy team , Health Plan; Eastern Standard Time Zone res

The Customer Care Associate is the main point of contact a customer makes with the health plan. Provides exceptional customer service to customers by answering questions and/or resolving concerns through appropriate education, information, and follow-up.

• Provides customers with knowledge of plans, products, systems, and processes to resolve customer issues/concerns.
• Serves as primary contact for customers.
• Maintains strong relationships with customers through telephone contact, written correspondence, electronic messaging and onsite visits.
• Investigates all concerns/issues to assure accurate information is provided in a timely manner. Provides resolution for all customer concerns and inquiries.
• Communicates and coordinates with the appropriate internal departments to resolve customer concerns.
• Documents and codes accurately all inquiries/concerns.
• Provides customers with the complaint/appeal and grievance process.
• Documents complaint/appeal and grievances and forwards to the appropriate team for processing.
• Completes outbound calls to customers to resolve complex benefit, eligibility, premium, pharmacy, claims or other related issues.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

#LI-REMOTE

• Hours of Operation are Monday thru Friday 8am - 8pm. Saturday 8am - 2pm.
• Shifts can change based on business need and process will be discussed during the interview & hiring process.
• During peak business times, and new election periods, extended hours may be required.

To ensure a productive and secure remote work environment, the following conditions must be met:

• Quiet, Dedicated Workspace: A private, distraction-free area within your home to support focused work.
• Adequate Workstation Setup: Sufficient space to accommodate all employer supplied equipment, including monitors, keyboard, and other peripherals.

Cable modem only (DSL, wireless cellular, and satellite services are not permitted).

• Download: 75 Mbps
• Upload: 25 Mbps
• Ping: Less than 150 ms
• Jitter: Less than 30 ms
• Connectivity: The computer must be connected via Ethernet cable. Wi-Fi is not permitted unless a Virtual Private Network (VPN) is used to secure the connection.