Spectrum Health Pharmacy Call Center Rep Priority Health in Grand Rapids, Michigan
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Inbound calls from members regarding denials, medications, benefit explanation and other covered alternative medications.
Inbound calls from Pharmacies.
Assisting with processing issues or general processing questions.
Assisting providers with requesting medication authorizations.
Learning the computer systems.
6 Weeks of training 8:30 a.m. to 5 p.m.
Post training shifts times vary starting at: 8:30 a.m., 9 a.m., 9:30 a.m., 10 a.m., and 10:30 a.m.
Once trained in Medicare start times can begin at 11 a.m. or 11:30 a.m.
(All 8 hour shifts)
Shifts are adjusted quarterly based on department/business needs
Weekends can vary based on department and business needs
$16.01- $17.01 based on relevant experience, education and department equity
Demonstrates high competency in analyzing, evaluating, and responding to complex service inquires from members, providers, employer groups, colleagues, agents, Elite agents, and different customer types across multiple Priority Health products within departmental guidelines. Professional and pleasant interactions are ongoing expectations.
Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status.
Promptly identifies and 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 customers 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.
Effectively 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.
Required High School Diploma or equivalent
Preferred Associate's Degree or equivalent
2 years of experience typically gained through skills/knowledge/abilities customer-facing service on phone or face to face; customer service, high volume call center, medical billing, insurance environment relevant to benefits, provider contracting, claims processing, and/or managed health care Required
1-2 years of experience in a retail, in-patient or pharmacy setting preferred
Licensed Pharmacy Technician preferred
SITE - Priority Health - 1231 E Beltline - Grand Rapids
PH - Pharmacy Contact Center
Weekly Scheduled Hours
Hours of Work
8:30 a.m. 8 p.m. ( See Job Posting for details)
Monday to Friday
Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).
Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected
category. See more here (https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf) .
Who We Are
Spectrum Health is a nationally recognized not-for-profit health system, offering a full continuum of health services through our health plan, medical group and hospital group. As an integrated health system, we are able to work together across all facilities, employees and providers to create exceptional, consumer-focused interactions.
Spectrum Health is redefining what it takes to improve the health of our communities and introducing new and innovative ways for consumers to access high-quality, low-cost care so that they can connect with us for a lifetime of health.
We strive to provide one Spectrum Health experience: a consistent, high-quality, seamless health journey for consumers; no matter where, when or how they interact with us. The result is better health outcomes for the thousands of individuals, families and communities we serve.
We are the region’s largest employer, with corporate offices located in Grand Rapids, Michigan. Spectrum Health Hospital Group and Spectrum Health Medical Group are consistently recognized for the exceptional care they provide. Priority Health is among the largest health system-sponsored health plans in the U.S. and offers extensive experience serving large and small employer groups, individuals, Medicare Advantage, Healthy Michigan Plan and Medicaid populations.
Since 2010, Spectrum Health has been listed five times among the 15 Top Health Systems in the U.S. by Truven Analytics™. Click here (https://www.spectrumhealth.org/about-us/quality-safety-and-patient-experience/awards) to see a complete list of our safety, quality and patient experience awards.