Member Services Representative

The Member Service Representative on our Customer Service and Support Team works directly with our members by answering calls, navigating software systems, responding to email inquiries, and collaborating internally to better resolve and understand member needs, issues, or concerns.

The Member Service Representative and Support Team acts as a full maintenance customer care center for our current and future members. The Member Service Representative is responsible for handling inbound calls from pharmacies, patients, doctor's offices, and more to resolve and document any technical issues, complaints, or suggestions. This role communicates predominantly on the phone and electronically with our customers to drive the efficient and effective savings solution for medications while keeping our internal team updated. You will use critical thinking skills and attention to detail to accurately determine the nature of the issue affecting the member. You will work to achieve success and smooth transitions for new members as well as continuing great service for our current customers. The goal of this position is to create the perfect experience for our members so they can relax and feel confident about their coverage through Drexi.

Job Responsibilities:

• Maintain confidentiality with respect to HIPAA guidelines.
• Provides a positive, high quality customer experience for members calling in regarding their coverage and to resolve any issues or concerns the member or pharmacy might be receiving.
• Utilizes technology and basic troubleshooting skills to determine the nature of the issue in our adjudication engine.
• Navigates multiple systems to identify the source of the issue.
• Properly documents and classifies member issues to ensure proper service and solutions are being implemented.
• Adheres with HIPAA standards and operational processes while working in a fast-paced environment.
• Achieves KPIs in a contact center-based production environment where productivity and quality are key in providing excellent customer experiences.
• Handles escalated callers constructively, constantly striving to provide positive outcomes for all our members.
• Manages real-time inquires while keeping track of and responding to commitments.
• Remains available on the phone to address all requests and customer questions.
• Provides information to supervisors and co-workers by instant messaging, phone calls, emails, or tickets.
• Demonstrates professionalism in communication, relationship development, customer service, etc.
• Shift flexibility will be required.
• Fosters a positive team environment.
• Ensure confidentiality and accuracy of internal and external data.
• Perform ad-hoc projects and other duties as assigned.

Skills and Abilities:

• Strong written and verbal communication skills to internal and external clients.
• Strong prioritization and problem solving skills.
• Ability to provide exceptional customer service to members via phone, email, and messaging systems.
• Ability to navigate multiple software applications and excel sheets with ease.
• Ability to work independently as well as in a team setting to achieve success.
• Ability to maintain organizational awareness.
• 40+ WPM typing skills required.

Qualifications:

• High school diploma required, Associates or Undergraduate degree preferred.
• Experience with Microsoft Office Suite (Word, Excel, Outlook) and Google Drive apps required.
• Previous experience in healthcare strongly preferred.
• Basic understanding of common healthcare terms and terminology strongly preferred.
• Previous experience in a customer service call center environment strongly preferred.
• English/Spanish Bilingual a plus.

Physical Requirements:

• Indoor office environment with moderate noise.
• Intermittent physical effort may include lifting to 25 lbs., walking, stopping, kneeling, crouching or crawling may be required.
• Frequent sitting, use of a keyboard, reaching with hands and arms, talking and hearing approximately 70% of the time; 30% or less time is spent standing.
• Normal vision abilities required including close vision and ability to adjust focus.