Job Description

Clinical Member Services Agent

We wanted a PBM that worked better\xe2\x80\xa6 so we created one.

Liviniti, the leading disruptor in the PBM industry, simplifies the complexities of navigating through the Pharmacy Benefit Manager world by offering a value-added approach to ensure the employer absolute freedom, control, and choice to their health plan structure without compromising patient experiences and outcomes. We improve healthcare and reduce rising prescription costs for employers and their employees. We are looking for individuals who are passionate, strong, and committed to developing systems and service solutions that promote our business goals and commitments.

Liviniti is searching for incredible talent! We continue to experience accelerated growth in a rapidly changing industry. There\'s never been a better time to join our team.

We are currently seeking a Member Services Agent. This is a remote position.

Role and Responsibilities

The Clinical Member Services Agent (CMSA) is responsible for providing effective customer service for all internal and external customers by using excellent, in-depth knowledge of company products and programs as well as communicating effectively with team members within the clinical department. The CMSA will work in conjunction with the member service agent to assist in clinical situations and resolutions.

• Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction. Confer with customers by telephone to provide information about Rx claims processing.
• Understanding of Pharmacy terms and formularies as a certified Pharmacy Technician (CPhT).
• Keep detailed records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
• Follow-up to ensure that appropriate changes were made to resolve customers\' problems.
• Refer unresolved customer grievances to designated departments for further investigation.
• Review Rx insurance policy terms to determine whether a claim is covered for employer group.
• Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
• Resolve customers\' service or billing complaints.
• Obtain and examine all relevant information to assess validity of complaints and to determine possible causes.
• Abide by all obligations under HIPAA related to Protected Health Information (PHI).
• If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.
• Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
• Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

Required Skills and Competencies

• Interacting with Computers \xe2\x80\x94 Using computers and computer systems (including hardware and software) to enter data or process information.
• Communicating with Supervisors, Peers, or Subordinates \xe2\x80\x94 Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
• Getting Information \xe2\x80\x94 Observing, receiving, and otherwise obtaining information from all relevant sources.
• Communicating with Persons Outside Organization \xe2\x80\x94 Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.
• Processing Information \xe2\x80\x94 Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
• Resolving Conflicts and Negotiating with Others \xe2\x80\x94 Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
• Updating and Using Relevant Knowledge \xe2\x80\x94 Keeping up-to-date technically and applying new knowledge to your job.
• Organizing, Planning, and Prioritizing Work \xe2\x80\x94 Developing specific goals and plans to prioritize, organize, and accomplish your work.
• Performing Administrative Activities \xe2\x80\x94 Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
• Making Decisions and Solving Problems \xe2\x80\x94 Analyzing information and evaluating results to choose the best solution and solve problems.
• Customer and Client Focus.
• Problem Solving and Analysis.
• Time Management.
• Communication Proficiency.
• Teamwork Orientation.
• Technical Capacity.
• Multitasking
• Competencies as a Certified Pharmacy Technician (CPhT).

Position Type and Expected Hours of Work

This is a full-time, hourly position. Days and hours of work vary on shift assigned. The Call Center hours of operation are Monday \xe2\x80\x93 Friday 6a \xe2\x80\x93 10p, Saturday 6a \xe2\x80\x93 8p, and Sunday 6a-8p CST. On-Call responsibilities are on a rotation basis.

This position reports to the Contact Center Supervisor.

Travel

Minimal travel expected for this position to Natchitoches, Louisiana for training and development.

Qualifications and Education Requirements

• High School or equivalent.
• Customer service experience.
• Certified Pharmacy Technician Certification (CPhT) with experience in a pharmacy setting.
• Computer experience.

Liviniti, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Liviniti complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Liviniti expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/V/D

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Southern Scripts