Eligibility Specialist - UBC

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POSITION SUMMARY

The Eligibility Specialist works collaboratively the eligibility team to reach proper solutions for management of all facets of enrollment into ESI’s Prescription Drug Plan (PDP) product.  This position is responsible for outbound calls for data collection and proper analyzing and processing of data.   

ESSENTIAL FUNCTIONS

  • Utilize and understand provider guidance and eligibility processes, in order to make necessary updates to various internal systems required for enrollment into ESI’s Prescription Drug Plan.

  • Serve as first point of contact for internal clients and members during the enrollment process.

  • Make outbound calls to members to gather Enrollment Data; analyze and process data accordingly. 

  • Handle inbound member calls and written correspondence regarding member eligibility.

  • Make independent judgments in order to respond to complex or critical member issues.

  • Work collaboratively with Eligibility Systems Analysts, other Eligibility Associates, Eligibility Managers and Account Managers to provide seamless support.

  • Identify and escalate repetitive questions and /or problems so that corrective action can be pursued and expedited.

  • Maintain accurate and complete documentation of all contacts.

  • This continuously improves the process and reduces potential for legal concerns or payouts.

  • Complete other projects and additional duties as assigned.

  • This position will provide daily mentoring and guidance to team members. 

  • This position will assist with reaching proper resolution of escalated critical concerns. 

  • Will assist in cross functional initiatives.   

QUALIFICATIONS

  • High School diploma, GED or equivalent work experience

  • 3-5 years experience in a customer service setting preferably in a call center environment;

  • Previous experience in the PBM and or Healthcare Industry preferred

  • Working knowledge of PC applications (i.e. Microsoft Office and Internet)

  • Proven leadership experience preferred;

  • Supervisor and/or coaching experience preferred;

  • Ability to work cross-functional to resolve complex client issues;

  • Strong project management and organizational skills;

  • Ability to manage timelines and balance multiple deadlines;

  • Ability to work a flexible schedule;

  • Demonstrated ability to handle internal and external customers in a professional manner;

  • Ability to adapt in a dynamic work environment,

  • Learns quickly, solves problems and make decisions;

  • Ability to navigate through multiple systems simultaneously;

  • Ability to act as a company ambassador when interfacing with clients to positively represent ESI’s vision, values, and client pledge

ABOUT THE DEPARTMENT

United BioSource Corporation (UBC), a subsidiary of Employer, is a leading provider of pharmaceutical support services, partnering with life science companies to make medicine and medical products safer and more accessible. Our services support the full lifecycle of medicine and medical products, including development, commercialization, and long-term value and safety.

While UBC offers employment within Patient Support, Nursing, Pharmacy and Corporate, two main focus areas for the company are Clinical Development & Research and Safety & Risk Management. Members of the Clinical Development and Research teams help evaluate study protocol, target study population, recruit physicians and patients, and collect, clean, validate and report data. As a result, sponsors are able to submit findings to regulatory authorities or make a no-go decision in a timely and clear-cut manner. Additionally, our Safety and Risk Management teams develop, deliver, and report evidence to reinforce safe and appropriate product use. 

Through our Patient Access services, we help patients begin therapy quickly and remain on therapy, building strong relationships with patients to ensure optimal care.

UBC aligns with Accredo and CuraScript SD, also part of the Employer family, to provide best-in-class, integrated services.

ABOUT EXPRESS SCRIPTS

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

Employer 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.

Employer is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation. Employer is a VEVRAA Federal Contractor.

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