Member Advocate

This is a fully remote position, open to applicants in Texas.

📋 Description

• Engage with members, pharmacies, and healthcare providers concerning pharmacy benefits.

• Address inquiries through phone, chat, and email communication.

• Offer assistance with formulary coverage, copayments, prior authorizations, and medication accessibility.

• Aid pharmacies in resolving questions and issues related to claim processing.

• Support providers with information on prior authorizations and drug coverage.

• Identify claims that need action, perform outbound follow-ups, and resolve issues.

• Manage complex or sensitive cases and adhere to escalation procedures.

• Collaborate with Clinical, Account Management, Operations, and other internal teams.

• Verify necessary data elements while complying with HIPAA and internal privacy regulations.

• Navigate through software, applications, and PBM tools effectively.

• Record interactions within the ticketing system.

• Engage in call quality assessments, apply coaching, and promote continuous improvement.

• Participate in team discussions and carry out additional tasks as needed.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• Prior experience in pharmacy benefit management (PBM) is strongly preferred; experience as a pharmacy technician, in healthcare, insurance, customer service, or call centers is highly regarded.

• A member-focused attitude with a commitment to enhancing the member experience.

• Highly effective verbal and written communication abilities.

• Capability to collaborate efficiently with peers and cross-functional teams.

• Proficient computer skills, including Microsoft Office, with the ability to swiftly learn new systems and technologies.

• Skill in multitasking, managing time effectively, and maintaining organization in a fast-paced, high-volume setting.

• Exceptional active listening, problem-solving, and critical thinking abilities.

• Availability to work Monday to Friday, from 12:00 PM to 9:00 PM CST.

🏝️ Benefits

• 401(k) with employer matching.

• Dental insurance.

• Health insurance.

• Vision insurance.

• Health savings account.

• Paid time off.

• High-growth environment with clear career advancement opportunities.

• A welcoming atmosphere and culture.