Customer Service Representative – Remote Jobs Houston

Job Type: Customer Service Representative from home
Location: Houston work from home
Company: Aston Carter

As a Member Services Representative, you will be responsible for handling incoming calls related to members’ prescription benefits. These inquiries may include questions about copays, medication coverage, and the authorization process for certain medications. It’s important to clarify that the company does not negotiate drug costs with pharmacies, is not a pharmacy itself, and is not an insurance company. Instead, you will provide information based on the pharmacy coverage offered.

Responsibilities:

• Address incoming calls regarding members’ prescription benefit inquiries.
• Explain and communicate client-specific prescription benefit and pharmacy claim processing details, including formularies, clinical programs, out-of-pocket costs, appeal rights, prior authorization procedures, and more.
• Educate members on how to maximize the benefits available to them.
• Troubleshoot pharmacy claims in real-time by verifying pharmacy-submitted information, comparing results to benefit rules, and making necessary overrides to facilitate claims processing.

Requirements:

Top Skills Details:

• Insurance verification
• Prior authorization
• Prescription benefits
• Call center experience

Additional Skills & Qualifications:

• 3+ years of prior medical customer service experience.
• A tenure of at least 2 years within the last 4 years.
• Strong phone etiquette and typing skills (minimum 40wpm or 500kph).
• Basic knowledge of Microsoft Office and internet usage is required, as you will review documents related to pharmacy benefits.
• Exceptional oral and written communication skills.
• Previous remote work experience is a plus.

Skills and Information for Applicants:

• Location: Specify the job location.
• This role involves assisting members with their prescription benefit inquiries and requires strong communication skills and attention to detail.
• Prior experience in medical customer service and a call center environment is essential.
• Proficiency in Microsoft Office and the ability to work remotely are advantageous for this position.