Prescription Drug Plan Specialist

Centene Corporation • Tallahassee, FL • 1d ago

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Job Specific Details:

Attend weekly call listening with vendors to provide feedback.

Attend 2x a week trends meeting with team to discuss what they are seeing and hearing in member interactions (on camera)

Review member interactions (chats, emails, calls) and provide feedback, this is not quality reviews but more focusing on overall process and member experience rather than agent performance.

Review sales agents and prospective member interactions, similar to above.

Root cause analysis (RCA), CTMs (Complaint Tracking Module), member complaints and escalations as needed.

Outreach to members, providers and pharmacies for escalations as needed.

Identify outdated tools & internal resources for member facing teams.

QA documents, lead lists, and deep dives as needed.

Meetings expectations are to participate in, more than just listening to updates.

Learn every different department, billing, enrollment, sales, pharmacy, complaints, CS quality, Pre-enrollment calls, and marketing issues.

The PDP Specialist will be part of PDP SWAT team. The ultimate goal of the SWAT team is to identify areas of opportunity within our member experience, particularly through our telecom centers. This role is the backbone of this as they are the ones reviewing the calls, providing the feedback, and sometimes helping to create the new call flows/tools.

Desired skills:

Pharmacy : Understanding Medicare Part D, particularly PDP is a plus.

Technical Proficiency : Sharepoint, Xcelys, & AWS. Able to manage large number of emails, filing, flagging, and managing follow-ups effectively, Excel (able to pivot, search, filter, and find trends).

Analytical Skills : Ability to conduct root cause analyses, evaluate interaction trends, and identify actionable insights.

Working shift: 8-hour shift with a flexible start between 8am and 9:30am (Eastern)

Position Purpose:

The Prescription Drug Plan Specialist works to improve the PDP member experience by collaborating with internal and external partners to alleviate pain points and drive process improvements. In addition, this role reviews/scores customer service calls, identifies trends, and solves escalated member complaints which include determining root cause.

Review calls for member and prospective members.

Score, identify opportunities, and place appropriate agent coachings and/or call back requests.

Deliver quality performance feedback to call agents and management.

Resolve complex executive leadership, Attorney General, and Department of Insurance complaints with members using critical thinking and investigative skills to.

This may include coordination across multiple departments for research along with providing a written or verbal response to the member as well as performing root cause analysis on a variety of complaints that come from Medicare directly to identify trends and opportunities for process improvement.

Participate in weekly internal team trends meeting which includes discussion around call opportunities and identification of short-term and long-term fixes.

Actively participate in weekly calibration sessions with customer service leaders and vendor partners.

Assist with special projects that help avoid complaints (including ones that go to Medicare directly) and access to care barriers.

Performs other duties as assigned

Complies with all policies and standards

Education/Experience:

Associate's degree, or equivalent experience, required. Bachelor's degree in a related field preferred. 5+ years of combined experience in pharmacy, Medicare Prescription Drug Plan, customer service, call center quality and oversight, complaint resolution, and/or Medicare sales required.

License/Certification: Certified Pharmacy Technician (CPhT) Preferred

Pay Range: $23.23 - $39.61 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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