Pharmacy Customer Service Representative

Let’s do great things, together!

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Overview:
The Pharmacy Customer Service Representative I position provides customer service to members of multiple benefit plans by analyzing the caller’s needs and by providing timely and accurate responses. Utilizes numerous programs and resources to answer calls from members (Commercial and UMP), agents, providers, hospitals, pharmacists, PBM and Mail Order carriers regarding pharmacy benefits, eligibility, claims or other issues. This is a FT WFH position.

Pay Range
$18.39 - $20.58 hourly, DOE.
*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position:

Primary Functions:

1. Responds to questions and assists customers via telephone, virtual meeting platform or in person regarding their claim benefit questions from callers on both group and individual pharmacy products. Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage.
2. Repeatedly analyzes situations, communicates effectively, and provides accurate information in a fast-paced environment that includes dealing with escalated situations and upset people.
3. Applies mathematical skills to provide and determine correct benefit information.
4. Reviews, updates, and becomes familiar with new and revised benefit information, regulations, benefit information and claim processing procedures.
5. Be familiar with drug names and recognize new drugs as they are released and added to the Moda drug list.
6. Requests claim adjustments required because of error or new information.
7. Resolves and record complaints, appeals, and inquiries.
8. Contacts physicians, pharmacies and PBM’s when necessary to answer questions and obtain or provide information.
9. Works with a culturally diverse population that can vary in age.
10. Provides timely follow up and return calls when required.
11. Maintains departmental service standards related to phone calls.
12. Continues education and training through on-the-job communication with Supervisors and/or tenured Customer Representatives and by attending trainings scheduled by leadership.
13. Consults with Leadership on problem cases and interfaces with interdepartmental personnel in resolving escalation questions.
14. Ability to maintain agreed upon work schedule and regularly work agreed upon shifts.
15. Performs other duties as assigned.

Required Qualifications

1. High school education or equivalent experience.
   
2. 1-2 years in a fast-paced customer service environment. A pharmacy or insurance setting preferred.
   
3. Type a minimum of 25-wpm on a computer keyboard
   
4. Ability to apply mathematical skills to provide and determine correct benefit information.
   
5. Proficient with Microsoft Office Applications, including Word and Excel and Outlook.
   
6. Strong verbal, written, and interpersonal communication skills. Ability to interact professionally, patiently, and courteously with
7. customers over the phone, in virtual meeting platforms and in person.
   
8. Proficiency in working thoughtfully and appropriately with a culturally, linguistically and ability diverse population.
   
9. Ability to work well under pressure; work with frequent interruptions, shifting priorities and quickly adapt to change.
   
10. Ability to work independently and as part of a team.
    
11. Ability to anticipate, meet and/or exceed customer needs and expectations in a professional manner.
    
12. Ability to come to work on time and on daily basis.
    
13. Maintain confidentiality and project a professional business image.
    
14. Ability to meet or exceed department standards and deadlines
    
15. Ability to multitask and efficiently utilize multiple (7-8) computer programs and packages at the same

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.

• Internally with Claims, Marketing, Billing and Eligibility, Sales, Healthcare Services, and Provider Relations. Externally with members, providers, attorneys, brokers, government officials, PBM’s and other insurance carriers.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.

For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email.