Healthcare Customer Service Representative

Healthcare Customer Service Representative – Pharmacy Benefits
Location: Augusta, ME
This position allows for 3 days of telework per week with management approval.
Pay Range: $18.00 per hour
Position Overview:
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.

Minimum Qualifications:

Training, education, or experience in office or administrative support demonstrating:

Proficiency with modern office practices and software
Ability to make independent decisions within established procedures

Knowledge or ability to learn:

Medicare, MaineCare, or healthcare program operations
Graphics, publications, and electronic content management
Information distribution via the internet and web pages

Demonstrated ability to:

Prepare business correspondence and standard reports
Interpret and apply laws, rules, policies, and procedures
Detect errors, analyze information, and resolve problems
Present information clearly to individuals and groups
Exercise sound judgment and attention to detail

Strong customer service, communication, and organizational skills

Benefits (Through SSO)
SSO offers a competitive benefits package, including:

Medical, dental, and vision insurance
401(k) with discretionary employer match
Paid time off and paid holidays
Flexible spending accounts (FSA)
Additional employee perks