Sachbearbeiter Krankenkassen (m,w,d) Customer Care Representative III

Position Overview

This position is responsible for providing excellent customer service, responding to customer inquiries, providing customers with coverage options, reimbursement processing, order placement, shipping status, warranty and general concerns. Assists with benefits investigation and answers a variety of reimbursement related questions. Strong communication between customers, physicians, healthcare and insurance providers are critical functions of this position. The Customer Care Specialist is able to independently follow standardized workflows as defined by the organization. Contact center/customer service experience is required, durable medical equipment as well as pharmacy coverage familiarity, reimbursement/insurance and healthcare experience is preferred. The Customer Care Specialist is not only responsible for ensuring a positive customer interaction, but will also ensure that benefits/coverage, prior authorization and documentation is correctly obtained which will allow Insulet to successfully collect revenue.

Responsibilities

• Process all aspects of the order process by verifying insurance benefits/coverage to determine eligibility and calculate cost share amounts for existing and new customers.
• Requesting and collecting updated documentation, prior authorizations, order entry and coordinating shipment of product to customers.
• Must maintain a thorough understanding of products offered by Insulet with the ability to explain basic operations and use to potential or existing customers.
• Understand Insulet channeling and processing requirements for all covered products, which is based on medical policy and payer guidelines.
• Answering phone inquiries and providing support and direction to customers and resolving customer service issues in a timely and empathetic manner.
• Work as part of the larger support team, collaborating with other departments to ensure proactive, superior front‑line customer support.
• Document all interactions and calls into the customer database and maintain compliance to HIPAA and other regulating bodies as required.
• Responsible for maintaining satisfactory call and order counts as defined by management.
• Provide frequent feedback and suggestions to support an environment of continuous process improvement.
• Calculate and document cost share amounts for potential customers.
• Collaborate with other commercial teams such as Case Management, OmniPod Sales and Billing, to ensure proactive communication of potential customer’s order status.
• Assist customers with the OmniPod orders via pharmacy and/or with Insulet directly.
• Effectively communicate to customers what is needed to fill a pharmacy order by managing retail, PBM (Pharmacy Benefit Manager).
• Obtain and or verify RX validity.
• Perform other duties as assigned.

Education and Experience

• Associate’s degree or equivalent combination of education and experience – preferred.
• Relevant call center, reimbursement, healthcare related customer service experience and pharmacy technician license/experience – preferred.
• Knowledge of medical device reimbursement from a manufacturer or DME perspective – preferred.
• Call center/customer service experience required.
• Knowledge of managed care industry is preferred.
• Knowledge of diabetes and experience supporting customers with diabetes is preferred.
• Bilingual skills a plus.
• Experience with Salesforce CRM – preferred.

Skills / Competencies

• Oral Communication – the ability to express oneself clearly in conversations and interactions with others.
• Written Communication – the ability to express oneself clearly in business writing.
• Fostering Teamwork – the ability and desire to work cooperatively with others on a team.
• Thoroughness – ensuring that one's own and others' work and information are complete and accurate; following up with others to ensure that agreements and commitments have been fulfilled.
• Stress Management – the ability to function effectively in a fast‑paced environment, while under pressure.
• Technical Expertise – demonstrating depth of knowledge and skill using standard business / office technology and applications.
• Other Important Skills / Competencies – flexibility, diagnostic information gathering, analytical thinking, initiative, self‑confidence and customer orientation.

Physical Requirements

• Requires sitting and standing associated with a normal office environment.
• Manual dexterity needed for using a calculator and computer keyboard.
• Lightweight lifting may be required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Travel: Regular travel to German branches as needed.

Location: Remote.