Liviniti · 1 week ago
Clinical Member Services Agent
Baton Rouge, Louisiana
Full-time
Onsite
New Grad, Entry LevelLiviniti is a company focused on providing excellent customer service in the healthcare sector. The Clinical Member Services Agent (CMSA) is responsible for assisting customers with inquiries related to Rx claims processing and ensuring high-quality service through effective communication and problem resolution.
BillingInsuranceRetail
Responsibilities
Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction. Confer with customers by telephone to provide information about Rx claims processing
Understanding of Pharmacy terms and formularies as a certified Pharmacy Technician (CPhT)
Keep detailed records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
Follow-up to ensure that appropriate changes were made to resolve customers' problems
Refer unresolved customer grievances to designated departments for further investigation
Review Rx insurance policy terms to determine whether a claim is covered for employer group
Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments
Resolve customers' service or billing complaints
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes
Abide by all obligations under HIPAA related to Protected Health Information (PHI)
If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources
Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company
Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice
Qualification
Required
High School or equivalent
Customer service experience
Certified Pharmacy Technician Certification (CPhT) with experience in a pharmacy setting
Computer experience
Knowledge of principles and processes for providing customer and personal services
Understanding of Pharmacy terms and formularies as a certified Pharmacy Technician (CPhT)
Abide by all obligations under HIPAA related to Protected Health Information (PHI)
Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company
Company
Liviniti
Liviniti specializes in pharmacy benefit management, offering services like prior authorization and drug price look-up.
Founded in 2011
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
LeAnn Boyd
CEO & Founder
Mike Stevens
Chief Financial Officer
Recent News
New Orleans CityBusiness
2025-09-23
New Orleans CityBusiness
2025-09-19
2025-07-16
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