Call Center Member Services Representative

The Call Center Member Services Representative provides high‑quality customer support to members, pharmacies, and providers in a Pharmacy Benefit Management (PBM) environment. This role is the first point of contact for benefit inquiries, claims questions, and pharmacy support. Representatives deliver accurate, empathetic service while navigating multiple systems and documenting interactions in real time.This position is ideal for individuals who thrive in a fast‑paced contact center, value teamwork, and take pride in delivering excellent customer experiences. Comprehensive paid training is provided.Flexible Work Hours:8:30am-5:00pm12:30pm-9:00pm1:30pm-10pm3:00pm-11:30pmKey ResponsibilitiesCustomer & Member SupportHandle inbound and outbound calls from members, pharmacies, and authorized representativesExplain pharmacy benefits, claims status, coverage, formularies, and prior authorizationsResolving issues professionally while maintaining empathy and clear communicationDe‑escalate challenging situations and focus on first‑call resolutionSystems & DocumentationNavigate multiple systems using dual monitorsAccurately document call details in real timeUse call center and internal platforms (e.g., RingCentral, SharePoint, ticketing systems)Submit service or system issues as neededQuality & ComplianceMeet performance metrics for quality, productivity, attendance, and customer satisfactionMaintain compliance with HIPAA, PBM policies, and data privacy standardsApply coaching feedback to continuously improve performanceTeam CollaborationWork closely with supervisors and teammates to resolve member concernsShare insights that help improve workflows and member experienceStay current on plan updates, system changes, and internal communicationsQualificationsRequiredHigh School Diploma or equivalent is requiredExcellent skills with dual monitors and multiple applications are requiredProficiency in Microsoft Outlook, Word, and Excel is requiredAbility to research and resolve benefit or pharmacy issues during live calls is requiredStrong customer service and communication skills are requiredHigh attention to detail and commitment to accuracy is requiredReliable attendance and schedule adherence are requiredPreferredContact center or call center experiencePBM, pharmacy, or healthcare experienceFamiliarity with claims, formulary, or prior authorization processesWhy Join UsPaid 10–12 week training programSupportive, team‑oriented contact center environmentOpportunities for growth within a stable PBM organizationMeaningful work that directly supports member health and care access