Member Services Representative

POSITION SUMMARY

The Member Services Representative will play a pivotal role in ensuring the satisfaction of our customers by responding to their inquiries, resolving issues, and providing information through email communication. Your primary responsibility will be to manage incoming customer service emails promptly and professionally, ensuring that each customer's needs are addressed effectively and efficiently.

DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

• Email Communication: Respond to incoming customer service emails in a timely and professional manner, ensuring accurate and helpful responses.
• Customer Support: Provide excellent customer support by answering inquiries, addressing concerns, and resolving issues related to prescription drug benefits, claims, coverage, and other pharmacy-related matters.
• Information Provision: Accurately convey information regarding prescription drug plans, formularies, prior authorizations, and pharmacy network details to members.
• Problem Resolution: Investigate and resolve member complaints or issues related to medication coverage, billing, and claims, ensuring a positive resolution for the customer.
• Documentation: Maintain thorough and organized records of all interactions, inquiries, and resolutions in the customer service email alias.
• Compliance: Adhere to all relevant policies, procedures, and compliance regulations in the healthcare and insurance industry.
• Continuous Learning: Stay updated on company policies, industry trends, and healthcare regulations to provide accurate and up-to-date information to customers.
• Collaboration: Collaborate with other customer service representatives and departments to address complex member issues and improve overall client and member experience.

Other job duties include, but are not limited to the following:

• Other duties may be assigned as needed.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)

• High school diploma or equivalent. A bachelor's degree or relevant certification in healthcare, customer service, or a related field is a plus.
• Bilingual in Spanish required - both verbal and written.
• Previous experience in customer service, preferably in a healthcare or PBM setting, is preferred but not required.
• Excellent written communication skills, with the ability to compose clear and concise emails.
• Strong problem-solving and critical-thinking skills.
• Empathetic and patient demeanor when dealing with customer inquiries and concerns.
• Proficiency in using email and customer service software systems.
• Ability to multitask, prioritize, and manage time effectively.
• Strong attention to detail and accuracy in handling customer information.

OTHER DETAILS

Supervisory Responsibilities

None.

Work Environment

The noise level in the work environment is usually low to moderate.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.

Travel Requirements

None.

NOTE

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.

The Company complies with employment regulations as they apply to the location of service.