Job Description
Job DescriptionWe are looking for a Customer Service Representative to support members with pharmacy benefit questions and service needs in Westminster, California. This is a Contract position within the healthcare industry, focused on delivering clear, timely, and detail-oriented assistance through high-volume phone-based interactions. The ideal candidate brings strong call center experience, attention to detail, and a commitment to helping members navigate coverage, refills, and related service requests.
Responsibilities:
• Respond to inbound member and prospective member inquiries related to pharmacy benefits, providing accurate and easy-to-understand information.
• Coordinate refill support with participating pharmacy partners when members need assistance completing the process.
• Escalate clinical questions or medication-related concerns to appropriate clinical leadership for further review.
• Collaborate with internal teams focused on medication adherence initiatives to help improve member engagement and outcomes.
• Take part in outbound and follow-up calling campaigns assigned by leadership to support member service objectives.
• Record interactions thoroughly in designated systems, including actions taken, required forms, and relevant follow-up details.
• Adhere to established policies, job aids, and workflow procedures while identifying process issues and suggesting practical improvements.
• Participate in team meetings, training sessions, and ongoing coaching to strengthen service quality and operational performance.
• Maintain compliance with applicable federal and state regulations as well as company standards governing health plan operations.
• Support additional service-related tasks and special assignments as needed by the department.• Minimum of 2 years of experience in customer service, preferably in a call center or healthcare-related environment.
• Ability to manage inbound and outbound calls professionally while delivering accurate and courteous service.
• Experience handling customer inquiries, service requests, or order entry with strong attention to detail.
• Clear verbal and written communication skills with the ability to explain benefit information effectively.
• Comfortable working in an environment that emphasizes regular coaching, feedback, and continuous improvement.
• Proficiency in documenting customer interactions accurately within computer-based systems.
• Strong problem-solving skills and the ability to follow procedures in a fast-paced, service-driven setting.