Pharmacy Cust Advocate I(Mason) - 40698JC - (US-OH-Mason - 45040)

Minimum Education: Tech School
Job Type: Full Time
Email this job to yourself or to a friend | Job Match Test | Resume Guide

WellPoint
is the nation's leading health benefits insurer and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to be the most trusted choice for consumers and a leader in affordable quality care with an unyielding commitment to meeting the needs of our diverse customers.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Responds to basic customer questions via telephone and written correspondence regarding pharmacy retail and mail order prescriptions. Primary duties may include, but are not limited to :Develops and maintains positive customer relations and coordinates with functions within the company to ensure customer requests are handled and resolved appropriate and in a timely manner.Interacts with internal and external customers (could include subscribers, providers, group or benefit administrators, physician offices, third party representatives, and other Blue Cross Plans) to provide claims, customer service, and/or membership support. Responds to client issues via telephone and written correspondence regarding insurance benefits member, provider contracts, eligibility, claims, etc. Completes necessary research to provide proactive, thorough solutions. Displays ownership of service requests ensuring high quality resolution and follow-thru. Supports and guides the customer with their personal options and decisions and helps the customer become knowledgeable and confident about using technology, tools and resources available to them.Promotes process improvement opportunities including responding to suggestions communicated by customers.Efficiently and effectively responds to a high volume of insurance information/service requests in a timely and accurate manner.Utilizes the appropriate computer systems to access and update a variety of information related to types of pharmacy coverage, services covered, provider networks, medical policy, benefits enrollment and changes, and related activities.Provides external and internal customers with requested information and effectively addresses and moderates escalated customer service concerns. Interprets and effectively communicates business jargon, insurance products, services, policies, and procedures when answering and resolving customer concerns. Reviews systems to ensure claims are paid or denied based on terms of contract. Initiates interaction with other areas to ensure claims are handled properly.Interprets claims to determine primary or secondary liability and recognizes when additional information is needed.Makes decisions on claims payments while considering benefit status, provider status, and impact on WellPoint, the provider, and the member.

Skills:
Requires a high school diploma; 18 months of experience in customer service and/or health insurance industry; or any combination of education and experience, which would provide provide an equivalent background. Experience with SmartScript, SmartCare Mail, SmartCare Retail, and/or ProServ. WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2008 DiversityInc magazine Top 50 Company for Diversity

To apply copy and paste the link below into your browser:

http://hispanic-jobs.com/view.php?job_id=76841&type=search&auth_sess=89be728f1c3c3f758aca51090a1b2e8d&ref=2d0931655958ea8bea4667903

There are so many more positions in any industry in all cities and states available on our website. Hispanic-Jobs.com specializes in jobs for bilingual English/Spanish-speaking professionals and applying to all jobs is free. Take a look, there are many wonderful opportunities available. Go directly to www.Hispanic-Jobs.com