Maximus is Looking for Customer Service Representative – PharmaCare Helpdesk, HIBC Full Time

Job Description:

Department Summary

On behalf of the B.C. government, Health Insurance BC (HIBC) administers medical coverage through the Medical Services Plan (MSP) and drug coverage through the PharmaCare and Fair PharmaCare programs. With a staff of ~180 unionized employees and 3 excluded managers, the HIBC Operations department delivers services measured by 20 SLRs and 29 SLOs via four teams:

• Customer Service (PharmaCare Help Desk, Service Desk, Info Support, and Prosthetics and Orthotics)
• Document Operations (Document Management, Document Processing, Admin Review, and Correspondence Liaison Unit)
• Practitioner and Patient Services (Provider Programs, Benefit Services, Billing Support, and In Province and Out of Country Adjudication)
• Operational Support Services (Medical Services and Pharmaceutical Services Support, Production Control, Support Coordinators)

Help Desk CSRs spend their day answering calls from pharmacists who have questions related to our provincial pharmaceutical system – PharmaCare. Our telephone system queues and monitors thousands of calls per month, therefore CSRs are expected to meet call handling targets.

CSRs are required to learn and use a variety of computer applications. They are also required to understand a large volume of policies, to explain them accurately, and to comply with them.

As the “face” of HIBC, CSRs will handle all calls pleasantly and professionally, even those that are more difficult in nature. Depending on the work shift and business need, this position also processes pharmaceutical claims that are mailed in.

• Answer and complete provider calls within 2:30 minutes to meet our Average Speed of Answer SLR of less than 1 minute
• Process documents provided providers, via HIBC forms and correspondence, to meet our SLO of 90 % documents processed within 20 business days
• Understand and comply to MAXIMUS Canada, legislated and client policies and work procedures accurately, 98% of the time to meet our Quality SLR and to provide excellent customer service
• Adhere to your work commitment and daily schedule 95% of the time so that MAXIMUS Canada can meet its business goals efficiently and reliably
• Manage your interactions with callers, clients and colleagues respectfully, collaboratively and professionally to contribute to a harmonious, productive work environment

• High school diploma or GED equivalent, required, may be subject to standardized testing
• Proficient knowledge of MS Office, Outlook, ability to operate standard office equipment
• Call centre experience preferred
• Fair Pharmacare experience an asset
• Must be able to work alone

Understand the Principles of:

• Call control and customer situational judgment
• Customer service
• Excellent and professional verbal & written communication skills
• Professional, pro-social inter-relations
• Privacy and security of personal information

Systems Use (B=basic I=intermediate A=advanced, E=expert)

MS Office Suite: I MaxPath: B Verint: B Cisco: I MaxImage: I RAPID: I Client Registry: B

Answer provider calls

• Verify callers and validate the information they provide
• Articulate PharmaCare program policies and procedures clearly, neutrally, and quickly
• Review account information and drug history to determine the correct response to a caller’s enquiry
• Calculate deductible amounts
• Update IT systems, as appropriate
• Troubleshoot provider connectivity problems and escalate issues appropriately
• Authorize temporary PharmaCare coverage, benefits and restrictions, after hours
• Assist callers in the use of and in submitting applications/documentation/claims
• Control calls
• Resolve transfers from other departments
• Track completed calls in CCA/ITG
• Perform repetitive tasks and answer repetitive questions
• Use a computer for long periods of time

Process documents provided by the providers

• Validate information and documentation provided by the providers, reject or accept applications and requests, as appropriate
• Apply the HIBC policies that pertain to the form/correspondence you are processing, at the level of work you are assigned, then update our IT systems accordingly
• Release (or not) personal information to 3rd Party Requesters
• Correspond with providers to explain policy decisions and to seek or provide information

Understand and comply to policies/procedures set by MAXIMUS Canada, legislation and our clients

• Comply to all regulations, policies and procedures, with minimal intervention
• Learn new policies, procedures and computer applications within designated timelines
• Escalate work or issues that are beyond the level you are assigned
• Report non-compliance of policies and procedures, regardless of the cause

Adhere to your work commitment and daily schedule

• Manage personal time with minimal impact to work time
• Track, update and adhere to schedules
• Request changes to your schedule as soon as you are aware of them, and with consideration of our planning needs
• Perform the work you are assigned within the designated targets and/or deadlines
• Report your time accurately, in the appropriate system, within deadlines

Manage your interactions with callers, clients and colleagues

• Articulate concerns, ideas and opinions in a professional manner
• De-escalate emotionally charged situations/calls
• Utilize pro-social skills (using manners, negotiation, problem solving, smiling, etc.)
• Participate in meetings and collaborations with good intent

Interpersonal Competencies

Relating Skills

• approachability
• interpersonal savvy

Managing Diverse Relationships

• boss relationships
• customer focus
• peer relationships

Being Open and Receptive

• composure
• listening
• patience

Demonstrating Personal Flexibility

• self-development
• self-knowledge

Business Competencies

Keeping On Point

• timely decision making
• priority setting

Getting Organized

• organizing
• time management

Communicating Effectively

Additional Information:

• An eligibility list may be established for this role.
• This is an auxiliary position working as and when required.