Customer Service Representative Pharmacy Call Center

Job Summary

Must be able to start on 05.19.2025

8 Weeks of training

Virtual Training Hours:

Monday to Thursday 8:30 a.m to 5:00 p.m.

Friday 8:00 a.m. to 4:30 p.m.

Mandatory attendance during the virtual training is required

Post training hours can vary

Call Center hours of operation:

7:30 a.m. to 10:00 p.m.

Shift lengths are variable and can be either 8.5 or 10 hours.

Must be available for weekend schedules

Inbound call center to assist and educate members, employer groups, providers, colleagues, or agents of the health plan benefits. Assess services, facilitate and resolve problems by understanding claims, billing and coding questions. Consistently create an exceptional experience with each contact, via inbound and outbound calls, face-to-face interactions, online chat, email, etc.

Essential Functions

• Analyzes, evaluates, resolves and responds to service inquiries from members, providers, employer groups, colleagues, agents, customers, and others within departmental guidelines. Professional and pleasant interactions are ongoing expectations.

• Partners with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status.

• Identifies, resolves or escalates customer concerns or complaints to achieve positive outcomes.

• Places outbound welcome calls to members to educate them on their benefits as needed. Assists walk-in members and agents if assigned by leadership.

• Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as corporate values and codes of excellence.

• Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements.

• Assists members with administrative issues, such as submitting enrollment record changes, providing letter explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed.

• Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments.

• Tracks and/or documents all service interactions with customers within appropriate systems according to guidelines.

• Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule.

Qualifications

Required

• Required High School Diploma or equivalent

• 1 year of relevant experience in related field

• Must have pharmacy experience

Preferred

• Associate’s degree

• Previous call center experience

• 2 years of recent pharmacy experience

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

PH - Customer Service West Region

Employment Type

Full time

Shift

Weekly Scheduled Hours

40

Hours of Work

7:30 a.m. to 10:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

Variable weekends

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