Remote Member Resolution Lead

Optimed Pharmacy Inc; Oshtemo Charter Township (MI); Hybrid; USD 65,000 - 90,000; Full time

Job summary

OptiMed Health Partners seeks a Member Resolution Expert to own complex member issues, investigate root causes, and coordinate cross-functional actions to resolution. The role focuses on enhancing member experience by aligning departments, processes, and timelines for effective service recovery.

The ideal candidate has strong analytical and communication skills and experience navigating pharmacy, reimbursement, and EHR systems to deliver timely, accurate resolutions across the member journey.

Qualifications

• Minimum 3 years in healthcare operations, specialty or infusion pharmacy, reimbursement, patient support, or related environment.
• Strong analytical, investigative, and problem-solving abilities.
• Excellent written, verbal, and interpersonal communication skills.
• Proficient with Microsoft Office (Outlook, Excel, Word, Teams).

Responsibilities

• Serve as the primary owner for complex member issues, escalations, complaints, and service recovery opportunities.
• Conduct comprehensive investigations using multiple systems (pharmacy, reimbursement, billing, CRM).
• Analyze member records and workflows to identify root causes and develop resolution plans.
• Track issues through resolution and escalate high-risk items to leadership when needed.
• Collaborate across departments to ensure timely and accurate resolution of member concerns.

Skills

Analytical skills

Investigative skills

Communication skills

Office software

Education

Associate degree

Bachelor's degree preferred

Tools

CRM platforms

EHR systems

pharmacy management systems

claims systems

Job description

OptiMed Health Partners seeks a Member Resolution Expert to own complex member issues, investigate root causes, and coordinate cross-functional actions to resolution. The role focuses on enhancing member experience by aligning departments, processes, and timelines for effective service recovery.

The ideal candidate has strong analytical and communication skills and experience navigating pharmacy, reimbursement, and EHR systems to deliver timely, accurate resolutions across the member journey.