Job details
Job type full-time
Full job description
**permanent work from homeYou must live within 100 miles from saint mary`s, ga or tampa, fl.**
Position summary
You will handle workers compensation pharmacy benefit inquiries from injured workers, providers, adjusters, pharmacies and internal/external clients related to workers compensation benefitsWork to research and resolve problems in a timely manner, while assisting with incoming callsAssist pharmacies and adjusters in understanding the pharmacy benefit claims submission, workflow and authorizations processAssist injured workers in understanding and maximizing the use of their workers compensation pharmacy benefit programUse computerized system to gather information and respond to questionsDocument issues and resolutions in a common databaseEscalate issues as necessary.
Essential functions
Handle inbound and outbound injured worker, provider, adjuster, pharmacy and internal/external client calls
Manage offline claims operations workflows with adjusters, pharmacies, providers and internal/external clients including eligibility, rejections, and authorizations.
Answer questions related to workers compensation pharmacy benefits, while maintaining productivity standards and performance guarantees where applicable
Work with other operational departments to research and resolve mail order and claims issues and respond to members within performance agreement guidelines
Maintain accurate and complete documentation of all inquiries in order to continuously improve the customer service process and reduce potential legal concerns
Identify and escalate in a prudent manner, concerns received from patients and/or clients so that corrective action can be pursued and expedited to take care of their needs
Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety
Other duties as needed
Qualifications
High school diploma or ged required.
1 year of relevant experience preferred.
General pc knowledge including microsoft office and internet.
Excellent verbal presentation and written communication skills.
Ability to handle challenging customers in a professional manner.
Ability to adapt in a dynamic work environment.
Learns quickly, solve problems and make decisions.
Willingness to work a flexible schedule for peak call and claims management times.
Note : we are currently training in a work at home environment, and you will be required to have reliable internet connectivity provided through a wired connectionA mobile or hot spot environment is not acceptable and you may need to purchase an ethernet cord depending on your current set up.
About the department
Mymatrixx® is a full-service workers compensation pharmacy benefit management company focused on
Patient advocacyBy combining clinical expertise and advanced business analytics, mymatrixx simplifies
Workers’ compensation claims management while providing safer medication therapy management.
About express scripts
At express scripts, we dare to imagine a better health care system, and we’re driven to make it happen.
Where some see obstacles, we see possibilitiesWe’re challengers, difference-makers and opportunity seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all.
We have always acted first to take on the toughest challengesWe uniquely partner across the health care
Ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes – like
No one else canWe believe health care can do moreWe are champions for betterExpress scripts, part of cigna corporation, unlocks new value in pharmacy, medical and beyond to further total health for all.
About cigna
Cigna corporation exists to improve livesWe are a global health service company dedicated to improving the health, well-being and peace of mind of those we serveTogether, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millionsThrough our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovationWhen you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s livesWhat difference will you make?
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: seeyourself@cigna.com for supportDo not email seeyourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
