QUALIFICATIONS:

Education and Certifications:

• Medical Allied Health graduate required (licensed/non-licensed)

• Strong pharmacovigilance/ drug safety review experience (preferred but not required)

Experience:

• Minimum 1 year of experience in a healthcare contact setting work experience (e.g.,

pharmacy technician, claims processor, provider services)

• Experience handling grievances or healthcare-related customer support in a

contact center setting

Other Requirements:

• Understanding of HIPAA and other healthcare regulations.

• Willingness to work flexible schedules, including US hours and holidays

 

Recommended Minimum Skills Requirements (MSRs):

1. Technical Skills:
   
   • Proficiency in Microsoft Office Suite (Word, Excel, Outlook)

1. Soft Skills:
   
   • Strong problem-solving and decision-making abilities
   
   • Excellent verbal and written communication skills in English
   
   • High level of empathy, patience, and active listening


2. Operational and Communication Skills:
   
   • Ability to prioritize tasks and meet deadlines in a fast-paced environment
   
   • Strong organizational and documentation skills
   
   • Accuracy and attention to detail
   
   • Ability to communicate effectively and convey complex information

KEY RESPONSIBILITIES:

1. Grievance Handling:
   
   o Investigate and resolve member grievances related to Medicare Part D drug
   
   coverage, claims, and pharmacy issues
   
   o Ensure all grievances are resolved within required CMS timelines and documented
   
   appropriately


2. Communication:
   
   o Act as a liaison between members, providers, and pharmacies for Medicare
   
   grievance resolution
   
   o Provide clear and empathetic communication throughout the grievance process


3. Compliance:
   
   o Adhere to all CMS (Centers for Medicare & Medicaid Services) guidelines and
   
   company policies
   
   o Maintain confidentiality of sensitive member information


4. Documentation:
   
   o Accurately document all interactions and resolutions in the client system
   
   o Prepare reports as required for compliance and auditing purposes


5. Collaboration:
   
   o Work closely with other departments to investigate and resolve grievances
   
   o Provide insights and feedback on recurring issues to improve processes