POSITION SUMMARY:



Work closely along with the drug interaction pharmacist team. Completing corrections for the drug interaction team processing refill too soon orders for drug interaction, C30 edits and quality review orders - initiation of phone outreach to prescribes and transfer of call to the drug interaction pharmacist. Document issues and resolution in a common database. Help to identify repetitive problems or questions in order to pursue process or procedural changes. May assist supervisor with work distribution and work plan development. Escalate issues as necessary.



ESSENTIAL FUNCTIONS:

Handle complaint inquires in a courteous, professional, timely and comprehensive manner in accordance with internal standards and Medicare guidelines.

Ensure all assigned work flow processes are followed and meet CMS and departmental requirements.

Be able to balance, organize, and prioritize several tasks at the same time.

Work closely with peers and Team Leads to complete work and ensure positive team experience.

Maintain a constant, even, and professional demeanor in dealing with ESI staff and other professionals.

Follow Standard Operations and Medicare Compliance Procedures, as well as, ensure all items are processed meeting turnaround time commitments.

Exercise good, sound professional judgment in decision making situations.

Demonstrate active participation in the Medicare Contact Center environment through exchange of information, escalation of issues, and reporting trends.

Analyze data for trend reporting and pattern control.

Report concerns to senior leadership and provide recommendations with solutions.

Become proficient utilizing multiple systems for research (SharePoint, CRTS, ESD, Verint, Facets, Marx).

Become proficient in business writing in order to draft formal member correspondence as needed.

Perform other duties as assigned.



QUALIFICATIONS:

HS Diploma or GED required.

Annual performance rating of Stretch preferred

Medicare experience preferred

previous administrative experience and/or business writing/communications experience preferred.

Low incident of quality monitoring failures.

Excellent attendance record is required.

Excellent organizational skills.

Proficient in the use of Microsoft Office Tools.

Previous experience in customer service, data entry, and/or claims preferred.

Ability to interact with all levels of personnel.

Outstanding internal customer service skills.

Ability to work independently and with a team to complete time sensitive tasks.

Excellent communication skills.

Ability to adapt to change.

Six months or longer time in service required.

Must not have received a Written or Final level of discipline in the past 6 months.

ABOUT EXPRESS SCRIPTS



At Express Scripts, we dare to imagine a better health care system, and we’re driven to make it happen. Where some see obstacles, we see possibilities. We’re challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all.



We have always acted first to take on the toughest challenges. We uniquely partner across the health care ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes – like no one else can. We believe health care can do more. We are Champions for BetterSM.



Express Scripts, part of Cigna Corporation, unlocks new value in pharmacy, medical and beyond to further total health for all.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.