Customer Service Representative - PAR (Premium Healthcare)
Experience: Job Code: REQ-021571
Sagility
Quezon City
job Details
Job title
Customer Service Representative - PAR (Premium Healthcare)
About Sagility
Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
A successful candidate will be able to interact effectively and efficiently with health care professionals using excellent interpersonal and listening skills, critical thinking, and problem-solving skills. The ability to multitask and use computer-based resources effectively is essential.
Confidently able to educate and provide accurate responses to inquiries is crucial for success. As a Prior Authorization Representative, you will be part of a dedicated team which provides information regarding pharmacy benefits and drug coverage. This crucial role is on the front lines with healthcare professionals, responding and addressing each phone inquiry with care, detail, and most importantly, empathy.
Job title:
Job Description:
Education & Experience:
- College degree of any 4-year course with at least one (1) year contact center experience.
- Completed at least 2 years in college with 2+ years’ contact center experience.
- Senior High School graduate with 2+ years’ contact center experience.
- Healthcare related call center experience with at least one (1) year prior authorization or pharmacy practices (medical & specialty claims) background is required.
Mandatory Skills:
- Exceptional customer service, computer, and telephonic skills required.
- Excellent communication skills in the spoken and written word.
- Ability to multi-task in fast-paced environment.
- Ability to handle and resolve escalated issues in a professional manner.
- Ability to adapt and stay motivated in an ever-changing environment.
- Strong decision-making skills to appropriately serve the customer.
- Strong organizational, time-management skills, with ability to prioritize tasks accordingly.
- Computer proficiency with Excel preferred.
Roles & Responsibilities:
- Responsible for providing high level of service to inbound calls and fax requests
- Collection of structured clinical data for prior authorization and non-formulary exception requests following the guidance provided in our online prior authorization tools and corresponding forms.
- Initial screening of requests based on guidance given by online prior authorization tools.
- Approves prior authorization requests if the data collected meets the approval specifications.
- Refers prior authorization requests that do not meet the approval specifications to a clinician for review.
- Independently responds to contacts ranging from routine to moderate complexity. May seek assistance with health care professionals for service issues of substantial complexity.
- Performs research to respond to inquiries and interprets policy provisions to determine the most effective response using established departmental procedures, HIPAA regulations, and corporate policies.
- Must be a champion of change and adapt well to frequent adjustments to procedures or guidance.
The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned.
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