Express Scripts Canada operates an inbound call centre which responds to benefit and claim inquiries from Pharmacy, Dental, Medical Supplies and Equipment and Extended Health Care Providers. The call centre, based in Toronto and Montreal, operates from 6:30am-midnight, 365 days a year.
The Customer Service Representative (CSR) is responsible for effectively addressing Providers claim adjudication queries regarding claim submission, payment, pricing, registration and audits. The CSR manages eligibility inquiries from Health Care Providers for pharmacy, dental, medical supplies and equipment and extended health care benefits.
The CSR responds to all inquiries in a prompt and professional manner understanding that performance is instrumental in meeting contractual objectives and service level commitments.
The frontline Customer Service Representative (CSR) must be able to work up to 35 hours per week and be flexible to work evenings, weekends and holidays. The CSR must adhere to a daily schedule (scheduled break and lunches), and maintain acceptable performance standards for talk, wrap time, and a call quality.
Respond to a steady volume of inbound calls from Health Care Providers for one singular line of business. (NIHB or Book of Business). Respond to inquiries regarding eligibility on multiple benefit types (Dental, Pharmacy, Medical Supplies and Equipment, Extended Health, Vision Care and Mental Health Counselling) and claim inquiries. Identify and assess Provider’s needs and achieve first call resolution on every call.
Provide accurate, valid and complete information in accordance with applicable call scripts and documented procedures manual.
Access a public or private claim system depending on training and various call centre applications to respond to inquiries.
Provide technical support to Providers where required in order for the Provider to submit claims electronically, assist in the navigation of public websites and troubleshoot on claims transmission errors.
Must keep abreast of procedural changes, circulated newsletters and external communications to ensure the most accurate information is communicated to Providers on the call.
Responsible to manage complaints and provide appropriate solutions and follow-up where required to resolve an inquiry. In cases of an escalated nature, the CSR will transfer the live call to a Supervisor for assistance
Participate in training and cross training for Pharmacy, Dental, Medical Supplies and Equipment, Vision Care, Mental Health Counselling and Extended Health benefits as required for skill development.
Attend regular team meetings for procedural updates and team building and coaching sessions as required for quality assurance and performance development.
High school diploma, general education degree or equivalent.
One year experience in a call centre or customer service environment.
Intermediate skills in MS Office. (Word, Excel, Outlook)
Strong keyboarding skills.
Knowledge of pharmacy benefits adjudication or the health insurance industry an asset.
Ability to work a flexible schedule, including evenings, weekends and statutory holidays.
Excellent verbal communication skills.
Strong phone contact handling skills and active listening.
Strong interpersonal skills with the ability to work independently and within a team environment.
ABOUT EXPRESS SCRIPTS CANADA
Express Scripts Canada, a registered business name of ESI Canada, an Ontario partnership indirectly controlled by Express Scripts, Inc. (Nasdaq: ESRX), is one of Canada’s leading providers of health benefits management services. From its corporate headquarters in Mississauga, Ontario, just outside Toronto, Express Scripts Canada provides a full range of integrated pharmacy benefit management (PBM) services to insurers, third-party administrators, plan sponsors and the public sector, including health-claims adjudication and processing services, Home Delivery Pharmacy Services, benefit-design consultation, drug-utilization review, formulary management, and medical and drug-data analysis services, to better facilitate the best possible health outcomes at the lowest possible cost.
It will be a condition of employment that the successful candidate receives the Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation in order to receive Clearance if required.
We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.
We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.
We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.
Thank you for your interest in this position however, only qualified candidates will be contacted for an interview. No telephone calls please.
For more information about Express Scripts Canada, visit its Web site at www.express-scripts.ca .
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.