Remote Member Services Representative

PharmaCentra, LLC

1d•Remote

About The Position

Join PharmaCentra as a remote Member Services Representative and become the trusted first point of contact for members seeking support with pharmacy benefits, coverage questions, and account assistance. In this fully remote role, you will deliver compassionate, accurate service in a fast-paced call center environment while helping members navigate important healthcare needs.

Requirements

High School Diploma or equivalent
1+ year of customer service, member services, healthcare, or call center experience
Ability to manage high call volumes in a fast-paced environment
Strong communication, active listening, and customer service skills
Detail-oriented with strong problem-solving skills and the ability to multitask across multiple systems
Proficiency in Microsoft Office (Excel, Word, PowerPoint, Outlook), CRM, or contact center platforms
Windows 10/11 PC (Intel i5/AMD Ryzen 5+, 8 GB RAM, 256 GB SSD)
Webcam
Noise-canceling headset (no Mac or Chromebooks)

Nice To Haves

Pharmacy benefits, managed care, claims, or healthcare experience preferred
Experience with claims processing and prior authorizations preferred

Responsibilities

Handle 40+ inbound calls daily with professionalism, empathy, and efficiency
Respond to member inquiries within service standards
Educate members on benefits, coverage, claims, and plan processes
Assist with prior authorizations, formulary exceptions, and appeals
Research and resolve issues using multiple systems in real time
Accurately document all interactions in CRM and internal systems
Escalate complex concerns while maintaining ownership of the member experience
Participate in training, coaching, team huddles, and performance improvement initiatives
Follow HIPAA/privacy standards, quality guidelines, and company procedures