Member Advocate

DisclosedRx

5d • Remote

About The Position

The Member Advocate I serves as a frontline representative, providing exceptional support and education to members in a fast-paced remote call center environment. This role is responsible for managing the general queue, responding to "Contact Us" requests, and delivering accurate, empathetic, and timely solutions. By ensuring a positive member experience through excellent service, clear communication, and efficient time management, the Member Advocate I plays a key role in building trust and satisfaction with our organization.

Requirements

• 1+ years of experience in member services or healthcare operations, preferably in pharmacy benefits or managed care.
• Proficiency with Contact Center as a Service (CCaaS) platforms, Microsoft Office, and CRM systems.
• Demonstrated ability to manage task queues and synopsis requests with accuracy and follow-through.
• Comfort navigating complex workflows such as prior authorization, formulary exclusions, and appeals.

Nice To Haves

• Advanced experience with CCaaS and CRM platforms.
• Familiarity with compliance and quality assurance standards in member-facing roles.
• Proficiency in claims processing and rejection resolution, with knowledge of pharmacy systems and tools (e.g., Tritium, Five9).
• Experience handling escalated member concerns with professionalism and accuracy.
• Strong collaboration skills, with proven ability to work effectively across teams and with leadership.

Responsibilities

• Manage an average of 40+ inbound calls daily from the general queue, providing professional and empathetic support.
• Respond to "Contact Us" submissions through the website within established service-level agreements.
• Accurately document all interactions and resolutions in the system.
• Navigate multiple systems and resources to troubleshoot and resolve member concerns in real time.
• Educate members on plan benefits, coverage, and processes to promote understanding and empowerment.
• Guide members through prior authorization, formulary exceptions, and appeal procedures as needed.
• Escalate complex issues to appropriate teams while maintaining ownership of the member experience.
• Actively participate in team huddles, training sessions, and performance reviews.
• Share feedback and insights to support continuous improvement in workflows and member satisfaction.
• Ensure compliance with privacy regulations, internal protocols, and quality standards.
• Perform additional duties as assigned to support departmental and organizational goals.

Benefits

• Comprehensive Benefits Package - Including medical, dental, vision, and life insurance.
• Paid Time Off & Holidays - PTO and company-observed holidays to support work-life balance.
• Professional Growth Opportunities - Ongoing training, career development, and the ability to grow into advanced roles.
• Remote Work Flexibility - Work from the comfort of your home with the tools and support you need to succeed.
• Collaborative Culture - Be part of a supportive, mission-driven team that values communication, accountability, and innovation.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed