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-5:00pm

12:30pm-9:00pm

1:30pm-10pm

3:00pm-11:30pm

Key Responsibilities

Customer & Member Support

• Handle inbound and outbound calls from members, pharmacies, and authorized representatives
• Explain pharmacy benefits, claims status, coverage, formularies, and prior authorizations
• Resolving issues professionally while maintaining empathy and clear communication
• De‑escalate challenging situations and focus on first‑call resolution
  
  

Systems & Documentation

• Navigate multiple systems using dual monitors
• Accurately document call details in real time
• Use call center and internal platforms (e.g., RingCentral, SharePoint, ticketing systems)
• Submit service or system issues as needed
  
  

Quality & Compliance

• Meet performance metrics for quality, productivity, attendance, and customer satisfaction
• Maintain compliance with HIPAA, PBM policies, and data privacy standards
• Apply coaching feedback to continuously improve performance
  
  

Team Collaboration

• Work closely with supervisors and teammates to resolve member concerns
• Share insights that help improve workflows and member experience
• Stay current on plan updates, system changes, and internal communications
  
  

Qualifications

Required

• High School Diploma or equivalent is required
• Excellent skills with dual monitors and multiple applications are required
• Proficiency in Microsoft Outlook, Word, and Excel is required
• Ability to research and resolve benefit or pharmacy issues during live calls is required
• Strong customer service and communication skills are required
• High attention to detail and commitment to accuracy is required
• Reliable attendance and schedule adherence are required
  
  

Preferred

• Contact center or call center experience
• PBM, pharmacy, or healthcare experience
• Familiarity with claims, formulary, or prior authorization processes
  
  

Why Join Us

• Paid 10–12 week training program
• Supportive, team‑oriented contact center environment
• Opportunities for growth within a stable PBM organization
• Meaningful work that directly supports member health and care access