We are looking for a Customer Service Representative to support members and prospective members with pharmacy benefit questions in Westminster, California. This Long-term Contract position is ideal for someone who thrives in a fast-paced call center setting and is committed to delivering accurate, compassionate service. The person in this role will handle benefit-related inquiries, coordinate refill support with network pharmacies, and ensure each interaction is documented thoroughly while meeting healthcare compliance standards.
Responsibilities:
- Respond to inbound member and prospective member inquiries related to pharmacy benefits, coverage details, and service options.
- Provide assistance with prescription refill coordination by working with approved pharmacy partners when additional support is needed.
- Escalate medication-related or clinical issues to appropriate clinical leadership for review and follow-up.
- Partner with internal teams focused on medication adherence to support outreach efforts and help improve member outcomes.
- Participate in assigned calling campaigns designed to enhance member service and strengthen engagement.
- Follow established procedures, reference materials, and departmental guidelines to complete work accurately and efficiently.
- Identify workflow challenges, communicate improvement ideas to management, and report operational issues through proper channels.
- Record member interactions, actions taken, and required follow-up in designated systems according to documentation standards.
- Attend team meetings, training sessions, and ongoing coaching activities to maintain service quality and performance expectations.
- Comply with all applicable federal, state, and organizational regulations, policies, and operational requirements.