Call Center Member Services Representative - BeneCard PBF

About the role

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. The 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.

Schedule

• 8:30 am – 5:00 pm
• 12:30 pm – 9:00 pm
• 1:30 pm – 10:00 pm
• 3:00 pm – 11:30 pm

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 and accurately document call details in real time.
• Use call center and internal platforms (e.g., RingCentral, SharePoint, ticketing systems) and submit service or system issues as needed.
• 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.
• 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

• High School Diploma or equivalent (required).
• Excellent skills with dual monitors and multiple applications (required).
• Proficiency in Microsoft Outlook, Word, and Excel (required).
• Ability to research and resolve benefit or pharmacy issues during live calls (required).
• Strong customer service and communication skills (required).
• High attention to detail and commitment to accuracy (required).
• Reliable attendance and schedule adherence (required).
• Contact center or call center experience (preferred).
• PBM, pharmacy, or healthcare experience (preferred).
• Familiarity with claims, formulary, or prior authorization processes (preferred).

Benefits

• 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.