Member Services Representative

RxBenefits, Inc. is looking for exceptional individuals to join their Member Services team as a Member Services Representative. This role serves as the first line of contact for customers, ensuring satisfaction by providing accurate information and solutions regarding prescription benefits.

Responsibilities

• Follow department procedures on such items as communication expectations, availability, time keeping, and attendance expectations
• Professionally handle a high volume of complex and highly varied inbound calls leveraging multiple different systems to complete the story for the customer
• Maintain strict confidentiality of sensitive information
• Guide the customer through the interaction using active listening and probing questions to ensure full understanding of the customer’s need and circumstance
• Perform detailed research using such tools as benefit documentation, multiple claim adjudication systems, prior authorization system, knowledge management system, etc
• Understand and communicate pharmacy benefit complexities to communicate medication coverage; includes deductible, copayment /coinsurance, maximum out of pocket, medication management tools such as prior authorization, and pharmacy network requirements
• Use various claim adjudication systems to prepare and run test claims to determine scenario-based outcomes of claim payment
• Use various claim adjudication systems to enter overrides per policy that allow rejected claims to process and ensure appropriate medication access for members
• Educate customer on various programs, products, and services including but not limited to, member portal registration and capabilities, specialty pharmacy requirements and registration, mail order status, cost saving programs such as discount card opportunities, and other utilization management opportunities
• Ensure questions and issues are resolved including anticipating future questions and/or asking probing questions to ensure all needs are resolved
• Promptly and accurately resolve customer needs in a manner that the customer (member, provider, pharmacy) can understand; verify understanding
• Effectively handle complaints using de-escalation techniques while consistently demonstrating behaviors that are respectful and contribute to good service
• Communicate with other professionals such as various vendor partner staff, pharmacy staff, pharmacists, medical office staff, and physicians to resolve customer needs
• Document customer interactions to ensure others can easily understand previous interactions and ensure a cohesive customer journey
• Focus on call quality ensuring customer satisfaction and first call resolution
• Actively participate in training and coaching opportunities to gain and advance personal skills and capabilities
• Act as a trusted partner within the Member Services team providing positive and supportive vibes
• All other duties as assigned

Skills

• High school diploma or its equivalent required
• Previous call center experience required
• Excellent application/system navigation skills
• Ability to connect multiple pieces of detailed information to complete a full picture for the customer
• Superior written and verbal communication skills
• Ability to collaborate internally for escalation and resolution
• Desire to be part of a dynamic team with a positive culture
• Maintain strict confidentiality of sensitive information
• Guide the customer through the interaction using active listening and probing questions
• Perform detailed research using such tools as benefit documentation, multiple claim adjudication systems, prior authorization system, knowledge management system, etc
• Understand and communicate pharmacy benefit complexities
• Use various claim adjudication systems to prepare and run test claims
• Use various claim adjudication systems to enter overrides per policy
• Educate customer on various programs, products, and services
• Ensure questions and issues are resolved
• Promptly and accurately resolve customer needs
• Effectively handle complaints using de-escalation techniques
• Communicate with other professionals to resolve customer needs
• Document customer interactions
• Focus on call quality ensuring customer satisfaction and first call resolution
• Actively participate in training and coaching opportunities
• Act as a trusted partner within the Member Services team
• Associate degree or bachelor's degree preferred
• Health or pharmacy benefit experience strongly preferred
• Use of multiple systems simultaneously while speaking with customers strongly preferred
• Experience with email and/or chat in addition to call strongly preferred
• Previous customer service experience within pharmacy operations helpful
• Spanish speaking bilingual abilities a bonus
• Knowledgeable in principals and protocols of phone etiquette and call center techniques
• Ability to follow specific processes to ensure HIPAA compliance and customer privacy
• High degree of professionalism in communicating complex topics
• Must demonstrate passion for caring for customers experiencing personal challenges
• Proficiency with Microsoft Office products including Word and Excel, Outlook email
• Self-motivated, self-starter, with a positive personality
• Excellent decision-making ability and problem-solving skills
• Ability to work for extended periods of time wearing a headset in a call center environment
• This position will require the applicant to be available during the hours of the customer support center which are 7a-8p CST Monday - Friday
• Proficient in business English, spelling, punctuation, and grammar
• Demonstrate proficiency in Microsoft Office products and Internet navigation
• Ability to communicate in a clear, concise, understandable manner, and listen attentively to others
• Ability to provide outstanding Member Services to a diverse customer base
• Ability to remain positive with difficult customers; ability to de-escalate
• Ability to handle non-routine customer calls that are highly variable

Benefits

• Remote first work environment
• Choice of a HDHP or PPO Medical plan, we pay 100% of the premium for the HDHP for you and your eligible family members
• Dental, Vision, Short- and Long-Term Disability, and Group Life Insurance that we also pay 100% of premiums (for your family too on Dental and Vision)
• Additional buy-up options for Short- and Long-Term Disability and Life Insurance
• 401(k) with an employer match up to 3.5% available after 60 days
• Community Service Day to give back and support what you love in your community
• 10 company holidays including MLK Day, Juneteenth, and the day after Thanksgiving plus a floating holiday to use as you like
• Reimbursements for high-speed internet, we’ll send you a computer and monitors to help you do your best work
• Tuition Reimbursement for accredited degree programs
• Paid New Parent Leave that can be used for adoption or birth
• Pet insurance to protect your furbabies
• A robust mental health benefit and EAP service through Spring Health to support you when you need it most

Company Overview