Medicare Grievance Specialist (Pharma Technicians)

Gratitude Inc

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4 days ago

Medicare Grievance Specialist (Pharma Technicians)

1-4 Year(s)

30 - 40 Thousand p.m

Quezon Calabarzon

Job Description

Key Skills

Communication Decision Making Microsoft Office Emotional Intelligence (EI) Grievances Support Experience

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QUALIFICATIONS:

Education and Certifications:

• Medical Allied Health graduate required (licensed/non-licensed)

• Strong pharmacovigilance/ drug safety review experience (preferred but not required)

Experience:

• Minimum 1 year of experience in a healthcare contact setting work experience (e.g.,

pharmacy technician, claims processor, provider services)

• Experience handling grievances or healthcare-related customer support in a

contact center setting

Other Requirements:

• Understanding of HIPAA and other healthcare regulations.

• Willingness to work flexible schedules, including US hours and holidays

Recommended Minimum Skills Requirements (MSRs):

Technical Skills:

• Proficiency in Microsoft Office Suite (Word, Excel, Outlook)

Soft Skills:

• Strong problem-solving and decision-making abilities

• Excellent verbal and written communication skills in English

• High level of empathy, patience, and active listening

Operational and Communication Skills:

• Ability to prioritize tasks and meet deadlines in a fast-paced environment

• Strong organizational and documentation skills

• Accuracy and attention to detail

• Ability to communicate effectively and convey complex information

KEY RESPONSIBILITIES:

Grievance Handling:

o Investigate and resolve member grievances related to Medicare Part D drug

coverage, claims, and pharmacy issues

o Ensure all grievances are resolved within required CMS timelines and documented

appropriately

Communication:

o Act as a liaison between members, providers, and pharmacies for Medicare

grievance resolution

o Provide clear and empathetic communication throughout the grievance process

Compliance:

o Adhere to all CMS (Centers for Medicare & Medicaid Services) guidelines and

company policies

o Maintain confidentiality of sensitive member information

Documentation:

o Accurately document all interactions and resolutions in the client system

o Prepare reports as required for compliance and auditing purposes

Collaboration:

o Work closely with other departments to investigate and resolve grievances

o Provide insights and feedback on recurring issues to improve processes

Role

Medical Specialist

Timings

Night Shift (Permanent)

Industry

BPO

Work Mode

Work from office

Functional Area

Medical Professional / Healthcare Practitioner / Technician

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