Specialist Operations Resolution

Job Description

REQUIREMENTS

• Bachelor’s degree in healthcare, business, or related area of study, or High School Diploma/GED and at at least 3 years of experience in n healthcare, business, or related area of study.
• 2 years’ experience handling client issues and providing recommendations for resolution within a pharmacy benefit plan (PBM), specialty pharmacy, home delivery pharmacy or other healthcare industry experience.
• Strong, effective interpersonal communication skills, both orally and in writing; excellent customer service skills interacting with internal and external customers at all levels; and strong organizational skills.
• Demonstrated ability to work independently and exercise good judgment; self-starter who proactively responds to problems and opportunities and requires minimal supervision.
• Proven ability to work collaboratively across functions and groups.
• Ability to actively listen and think critically to identify solutions; history of success in tracking and managing multiple escalations at once, with providing follow-up in a timely manner.

RESPONSIBILITES

• Manages assigned casework of escalated patient and client interactions and/or complaints through effective written and verbal discussions that are clear and concise; successfully navigate through de¬ escalation efforts due to dissatisfied patients and clients.
• Critically problem-solve escalated complaints by flagging trends and partnering cross-functionally to recommend and implement preventative measures; perform trend analysis using service delivery tracker, windshield, and complaints.
• Supports internal teams by delivering timely feedback to empower the delivery of exceptional patient and client experiences; clarify, manage, and prioritize all client requests relative to operational processes.
• Resolves complex issues including escalations through executive leadership and social media platforms.
• Addresses and resolves challenging or difficult situations within established turnaround timelines, while maintaining proper documentation in resolution platforms.
• Supports the development and implementation of programs that drive efficiencies and process improvements.
• Supports the preparation of review of daily, weekly, and monthly reporting.
• Oversees SPOC (single point of contact) patients.
• Other responsibilities as judgment or necessity dictates.

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