Healthcare Customer Service Representative – Pharmacy Benefits

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.
• Aid 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)

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

This position allows for 3 days of telework per week with management approval. Pay Rate: $18.00 per hour.