Pharmacy Service Representative -

Medix™; United States; On-site; USD 42,000 - 62,000; Full time

Job summary

Medix is seeking a Member Support Specialist to assist members, pharmacies, and providers with pharmacy benefits, coverage, and prior authorizations. You will serve as a frontline liaison in a PBM environment, guiding members through complex insurance processes with patience and professionalism.

Ideal candidates bring experience in high-volume call centers, outstanding communication, and a knack for documenting interactions accurately in internal systems.

Qualifications

• Previous experience in a high-volume call center environment.
• Strong customer service and communication skills.
• Ability to explain complex processes clearly.
• Accurate documentation of interactions.
• Ability to work independently in a fast-paced setting.

Responsibilities

• Handle inbound and outbound calls about pharmacy benefits and coverage.
• Assist members with prescription coverage, eligibility, and prior authorizations.
• Explain prior authorization requirements and next steps.
• Resolve prescription claim rejections and coverage issues for pharmacies.
• Guide members to online portals and troubleshoot access.
• Document interactions and resolutions in internal systems.
• Collaborate with internal teams to resolve complex issues.
• Manage 45-50 calls per day during peak periods.

Skills

Call center experience

Customer service

Verbal communication

Active listening

Problem solving

Documentation

Multi-system navigation

Tools

CoverMyMeds

PBM systems

Job description

Schedule: Monday-Friday, 8:00 AM-5:00 PM CST

Position Overview

We are seeking a customer-focused Member Support Specialist to support members, pharmacies, and healthcare providers with questions related to pharmacy benefits, prescription coverage, and prior authorizations. This role operates within a Pharmacy Benefit Management (PBM) environment and serves as a primary point of contact for resolving medication access issues and helping members navigate their pharmacy benefits.

The ideal candidate has a strong background in call center customer service, excellent communication skills, and the ability to guide members through complex insurance and pharmacy-related processes with patience and professionalism.

Key Responsibilities

• Handle inbound and outbound calls from members, pharmacies, and prescriber offices regarding pharmacy benefits and medication coverage.
• Assist members with questions related to prescription coverage, eligibility, rejected claims, and prior authorization requirements.
• Explain the prior authorization process, including requirements, denials, and next steps for obtaining medication approval.
• Support pharmacies and healthcare providers in resolving prescription claim rejections and coverage-related issues.
• Help members navigate online portals, including account registration, accessing benefit information, and troubleshooting basic issues.
• Provide personalized guidance to members who may require additional assistance understanding their benefits or navigating healthcare processes.
• Research and resolve member inquiries while ensuring accurate and timely communication.
• Document member interactions, case updates, and resolutions within internal systems.
• Collaborate with internal teams to elevate complex issues and ensure members receive appropriate support.
• Manage an average of 45-50 inbound and outbound calls daily during peak periods while maintaining a high standard of customer service.

Required Qualifications

• Previous experience working in a high-volume call center environment.
• Strong customer service skills with the ability to handle complex or sensitive member inquiries.
• Excellent verbal communication, active listening, and problem-solving skills.
• Ability to explain complicated processes clearly and professionally to individuals with varying levels of understanding.
• Strong attention to detail and ability to accurately document interactions.
• Comfortable navigating multiple computer systems while managing customer calls.
• Ability to work independently in a fast-paced, service-oriented environment.

Preferred Qualifications

• Previous experience working within a Pharmacy Benefit Manager (PBM), health insurance organization, pharmacy, or healthcare support environment.
• Familiarity with pharmacy benefits, prescription claims, insurance eligibility, and prior authorization processes.
• Experience using CoverMyMeds or similar prior authorization platforms.
• Experience assisting members with medication access, prescription coverage issues, or healthcare benefit navigation.
• Schedule: Monday-Friday, 8:00 AM-5:00 PM CST
• Call Volume: Approximately 45-50 calls per day during peak periods
• Primary Focus: Pharmacy benefit inquiries, with approximately 60% of member interactions involving prior authorization questions or discussions.