Job Summary

Key Duties

• Answer customer service phone calls.
• Respond to inquiries submitted via email or otherwise by customers.
• Provide external training of the program to providers as needed, using tools like WebEx, Microsoft Teams, etc.
• Research, identify, resolve, and escalate customer service inquiries as needed.
• Track and report internal claims or system-related issues as needed.
• Assist with monitoring daily claims activity and assist with resolving claim rejections and denials.
• Participate in company meetings.
• Performs other duties as assigned by RedSail Technologies management.

• High school diploma or general education degree (GED).
• Pharmacy Technician Certificate desired but not required.
• PMS/EMR system and customer support experience preferred.
• PBM and/or medical plan provider claims support experience desired.
• Pharmacy Technician Certificate desired but not required.

• Must have experience in the health industry (minimum of 1 year).
• Must have pharmacy and medical billing software experience.
• Must have excellent computer skills and medical terminology knowledge.
• Must have knowledge of insurance billing standards for medical and pharmacy services.
• Must be able to effectively manage multiple priorities.
• Must be a problem solver with the ability to identify and resolve discrepancies and errors.

• Must have excellent communication, customer service, and interpersonal skills.
• Must have expertise in Excel and Word, with the ability to manage and maintain multiple detailed worksheets.

• Excellent written, verbal, and presentation skills.
• English is required, the ability to speak Spanish is preferred.

• Uses independent judgment and discretion based on the employee’s experience in the position and knowledge of the products, equipment, and services
• Uses good judgment and possesses ethical work values

• Moderate levels of stress may be experienced in the performance of the job
• Position is performed in a general office environment, home office, or approved remote workspace where physical work includes, but is not limited to, sitting, standing, reaching, kneeling, bending, and lifting to 25 lbs.

• Daily use of Microsoft Teams (phone), computer, printer, and other routine office equipment
• Must have internet access.

• Little responsibility for the safety of others. Job is performed in an office setting where there are no hazardous materials or equipment

Working Conditions/Hazards

• Position is performed in an open office environment or approved remote work location