Call Center Member Services Representative

Key Responsibilities

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

Qualifications

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