Onsite Orlando Member Support Specialist

primetherapeutics; United States; Remote; USD 25,000 - 34,000; Full time

Job summary

Prime Therapeutics, a national PBM, is seeking a Customer Care Specialist in Florida (Orlando area). The role focuses on providing exceptional support to members and providers, handling eligibility, benefits, claims, and service authorizations, with the goal of resolving issues on the first call and upholding quality standards.

Responsibilities include engaging callers, outbound outreach for issues and prior authorizations, researching information across systems, entering data for EAP and

Qualifications

• High school diploma or GED required.
• Eligible to work in the United States without visa sponsorship.
• On-site role; Florida residents preferred.
• Proficient typist with 35+ WPM and strong written/verbal communication.
• Ability to multi-task in a high-volume call center.

Responsibilities

• Handle inbound calls and resolve administrative concerns efficiently.
• Make outbound calls to resolve member issues or obtain information for prior authorizations.
• Research eligibility, benefits, claims, and authorizations while maintaining confidentiality.
• Enter patient data for EAP, Care, and Utilization Management accurately.
• Educate providers and members on claims submission, treatment plans, appeals, and reimbursements.
• Identify and respond to crisis calls and triage as needed.
• Support continuous improvement by identifying inefficiencies and completing follow-up tasks.
• Document interactions and route inquiries to the appropriate teams.

Skills

Customer service

Typing 35+ WPM

Communication skills

HIPAA knowledge

Call center experience

Education

High school diploma or GED

Tools

Genesys

CRM platforms

Job description

Prime Therapeutics, a national PBM, is seeking a Customer Care Specialist in Florida (Orlando area). The role focuses on providing exceptional support to members and providers, handling eligibility, benefits, claims, and service authorizations, with the goal of resolving issues on the first call and upholding quality standards.

Responsibilities include engaging callers, outbound outreach for issues and prior authorizations, researching information across systems, entering data for EAP and