at Staffing Solutions Organization LLC in Augusta, Maine, United States
Job Description
The Healthcare Customer Service Representative – Pharmacy Benefits supports MaineCare members, pharmacies, and healthcare providers by providing customer service, education, and technical assistance related to prescription coverage, Medicare Part D, and MaineCare pharmacy benefits. This role requires strong communication skills, attention to detail, and the ability to apply policies and procedures accurately.
Key Responsibilities:Customer & Member Support
- Respond to inbound calls from MaineCare members, pharmacists, technicians, and other stakeholders.
- Educate members on Medicare Part D plans, Medicare Savings Programs, and MaineCare pharmacy benefits.
- Assist members with enrollment, coverage questions, and benefit explanations.
- Resolve issues related to copays, deductibles, premiums, medication access, and prescription fills.
- Support members who are out of medication or unable to fill prescriptions.
Claims & Coverage Support
- Review insurance coverage for pharmacies, providers, hospitals, and members.
- Support claims processing activities including evaluation, pricing, and service requests.
- Apply rules, regulations, policies, and documentation requirements to individual cases.
Administrative & Technical Support
- Create, edit, and manage correspondence, reports, and informational materials.
- Develop and maintain computerized forms, graphics, charts, tables, and web content.
- Examine documents, identify errors or irregularities, and take corrective action as authorized.
- Perform routine administrative duties including scheduling, coordinating meetings, and responding to inquiries.
- Track and monitor contracts, licenses, fees, and reports; reconcile funds as required.
Training & Leadership (as assigned)
- Coordinate and present training, workshops, and orientation sessions.
- Develop standard work procedures within established guidelines.
- Provide work direction and support to team members as needed.
- Confer with supervisors on performance matters when applicable.
Compliance
- Comply with all State policies, information security standards, and confidentiality requirements.
