Summary
An OTC Customer Service Representative assists Medicare Advantage and Medicaid members with their OTC benefits and product orders. The role is primarily an inbound customer service position focused on helping members understand and use their health plan benefits.
Key Responsibilities
- Answer inbound calls from health plan members regarding OTC benefits and orders.
- Process OTC product orders received by phone or mail.
- Assist members with new orders, reorders, order status, and issue resolution.
- Update member account information, including addresses, phone numbers, and other records.
- Educate members about plan benefits, coverage limits, eligible products, and order frequency.
- Document interactions accurately in member records.
- Research and resolve customer concerns and escalate complaints when necessary.
- Verify OTC product eligibility and explain coverage guidelines to members.
- Maintain compliance with healthcare regulations, including HIPAA requirements.
Qualifications
- High school diploma or equivalent preferred.
- At least 6 months of customer service experience preferred.
- Call center experience preferred.
- Healthcare, Medicare, Medicaid, or pharmacy experience is a plus.
- Strong communication, problem-solving, and customer-care skills.
- Good computer proficiency and ability to work across multiple systems simultaneously.
