Are you ready to POWER UP your skills Take the leap and join Concentrix's League of TOP-NOTCH TALENTS! Prepare for an Extra-Ordinary Journey where you not only Collaborate with Industry Champions but also immerse yourself in an Innovative Workplace filled with Laughter, Continuous Learning, and Limitless Opportunities. Join the Leading Global Provider of CX and Tech Services and seize this moment to #JoinConcentrix!
Essential Duties and Responsibilities:
- Quality Evaluation and Analysis: Monitor(s), Evaluate(s) and Audit(s) a Sampling of Inbound or Outbound Call(s) and Other Contact Method(s) Including Chat(s) and Email(s), Participate in Calibration and Call Listening Session(s) with Quality Staff, Delivery, and Client(s) to Ensure Scoring Consistency and Best Practice(s), Participate in Internal Quality Audit(s) Designed to Improve Overall Contact Quality and Recommend Change(s), Meet Audit Requirement(s) and Report Result(s) of Completed Evaluation(s) to Different Stakeholder(s)
- Grievance Handling: Investigate and Resolve Member Grievance(s) Related to Medicare Part D Drug Coverage, Medical Claim(s), and Pharmacy Issue(s) - Ensure all Member Grievance(s) are Resolved within the Required CMS (Center(s) for Medicare and Medicaid Service(s)) Timeline(s) and Documented Appropriately
- Communication: Act as a Liaison Between Member(s), Medical and Healthcare Provider(s), and Pharmacies for Medicare Grievance Resolution - Provide Clear and Empathetic Communication with Patient(s) throughout the Grievance Process and Transaction(s)
- Compliance and Documentation: Adhere to all CMS (Center(s) for Medicare and Medicaid Service(s)) Guideline(s) and Company Policies, Maintain Confidentiality of Sensitive Member Information - Accurately Document all Interaction(s) and Resolution(s) in the System, Prepare Report(s) for Compliance and Audit Purposes
- Collaboration: Work Closely, Partner, and Collaborate with Other Department(s) to Expedite Grievance Resolution - Provide Insight(s) and Feedback on Recurring Issue(s) to Improve Existing Practice(s) and Process(es)
Minimum Hiring Qualifications:
- Bachelor's Degree in Nursing or a Pharmacy Related Field is Preferred, or Relevant Experience in a Pharmacy Related Role - 1 Year(s) Experience as a Pharmacy Technician (Drug Safety Review or Pharmacovigilance)
- Experience as a Quality Analyst (Senior Quality Analyst) in a Similar Support Environment - Other Related Role(s) Exposed to Related Function(s) are also Considered
- Contact Center Experience is an Advantage (Similar Job Function(s)), License(s) or Certification(s) are Not Required
- Understanding of HIIPA and Other Related Healthcare Regulation(s), Knowledge of Pharmacy Operations, Familiar with CRM Tool(s) and Relevant Healthcare Platform(s), Proficiency in Microsoft Office Suite (Microsoft Word, Microsoft Excel, and Microsoft Outlook)
- Willing to Work On-Site with Flexible Work Schedule(s) Including US Hour(s) and Holiday(s)
Get Hired and Enjoy the Following:
- Interact/Collaborate and Learn from Industry Experts
- Multiple Opportunities for Learning and Development
- Enjoy a Fun - and Competitive Working Environment
Work Location: Tera Tower, Bridgetowne, Quezon City
