Express Scripts Patient Care Advocate II in Dublin, Ohio

POSITION SUMMARY

The Grievance team works to resolve issues following guidance from the Centers for Medicare and Medicaid Services (CMS) Chapter 18 of the Prescription Drug Benefit Manual. They are responsible for identifying root cause of a beneficiaries issue, researching the issue, making outreach internally and/or externally to reach a resolution, and resolving any complaint or dispute (other than a coverage determination or an LEP determination) expressing dissatisfaction with any aspect of the operations, activities, or behavior of a Part D plan sponsor, regardless of whether remedial action is requested.

ESSENTIAL FUNCTIONS

  • Handle complaint inquires in a courteous, professional, timely and comprehensive manner in accordance with internal standards and Medicare guidelines
  • Ensure all assigned work flow processes are followed meeting CMS and departmental requirements
  • Work with team and contribute to positive team experience
  • Maintain a constant, even and professional demeanor in dealing with staff and other ESI professionals
  • Follow Standard Operations and Medicare Compliance Procedures to ensure all items are processed meeting turnaround time commitments
  • Exercise good, sound professional judgment and decision making
  • Demonstrate active participation in the Medicare Service Center environment through exchange of information, escalation of issues and reporting trends
  • Analyze data for trend reporting and pattern control
  • Report delays to senior leadership as well as providing recommendations with solutions for set guidelines
  • Become proficient utilizing multiple systems for research (CRTS, ESD, Facets, Marx)
  • Provide SME support as needed
  • Compose resolution letters
  • Perform other duties as assigned

QUALIFICATIONS

  • High school diploma or equivalent; and 2-5 years of relevant work experience
  • Prior Medicare Part D experience is required
  • Previous administrative experience and/or letter writing required
  • Excellent organizational skills
  • Proficient in the use of Microsoft Office Tools
  • Previous experience in data entry, customer service, and claims
  • Ability to interact with all levels of personnel
  • Outstanding internal customer service skills
  • Ability to work independently and adapt to change
  • Excellent verbal and written communication skills
  • Ability to handle challenging customers in a professional manner.
  • Solve problems and make decisions.

ABOUT THE DEPARTMENT

The Pharmacy Operations Group is crucial to achieving our mission of practicing pharmacy smarter and putting medicine within reach. Members of this team are at the front line every day interacting with patients, strategizing on improvements and efficiencies, and processing the more than one million prescriptions that come through our world-class pharmacies and distribution facilities across the country.

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ABOUT EXPRESS SCRIPTS

Advance your career with the company that makes it easier for people to choose better health.

Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.

Express Scripts is an equal opportunity employer/disability/veteran.