Contact Center Member Services Representative - Bonita Springs
5 hours ago
Job description
The Member Services Representative plays a critical role in delivering compassionate, accurate, and high‑quality support to members, pharmacies and physicians within the Contact Center.
This is a Pharmacy Benefit Management (PBM), team environment.Guided by the values of honesty, respect, empathy, innovation, uplift and ownership, this role requires a service‑minded professional who uplifts others, takes pride in their work, and is committed to improving the member experience with every interaction.
As the first point of contact, the representative provides prompt and reliable support to members, pharmacy partners, and authorized representatives—resolving inquiries with patience, clarity, and professionalism.
Representatives stay current on evolving benefit policies, plan updates, and system enhancements to ensure accurate guidance and efficient issue resolution.
Benecard PBF invests in your success through a comprehensive 10–12‑week paid training program and fosters a collaborative, team‑oriented environment where your contributions truly make a difference in people's lives.
With opportunities for growth, flexible scheduling, and the stability of a respected, award winning PBM organization, this role is ideal for individuals who thrive in a purpose‑driven, member‑focused environment and take ownership of delivering excellence on every call.
Key ResponsibilitiesMember Support & Service Excellence
Deliver prompt, accurate, and empathetic support to members, pharmacy partners, and authorized representatives while upholding the values of honesty, respect, and empathy.
Provide clear guidance on pharmacy benefits, medication coverage, claims status, prior authorizations, and general plan inquiries.
Technical Navigation & Documentation
Navigate multiple systems simultaneously using dual monitors, maintaining speed, accuracy, and attention to detail.
Document all call details thoroughly and in real time across internal platforms.
Utilize RingCentral for call handling, interaction history, and performance‑related metrics.
Access and utilize team resources in SharePoint to ensure information accuracy and process alignment.
Submit and monitor issue tickets through JIRA to support system fixes, trend reporting, and workflow efforts.
Quality, Compliance & Performance
Meet or exceed established benchmarks for Quality, Service Level, AHT, adherence, and customer satisfaction.
Maintain compliance with PBM policies, HIPAA regulations, and all privacy/security standards.
Participate in Calabrio QA review processes by applying coaching insights and striving for continuous improvement.
Support the team's performance through reliable attendance, schedule adherence, and active participation in team meetings.
Collaboration & Continuous Improvement
Partner with supervisors, leads, and teammates to resolve member concerns and ensure a seamless experience.
Identify recurring issues and share insights that support workflow enhancements, innovation, and process improvements.
Demonstrate ownership and uplift by proactively contributing ideas, offering support to peers, and modeling a positive team‑first mindset.
Stay up to date on evolving benefit policies, system enhancements, and internal communications.
Professionalism & Member-Centered Care
Provide culturally competent, respectful, and empathetic service to members from diverse backgrounds.
Maintain professionalism and calm composure during difficult interactions, focusing on de‑escalation and solution‑finding.
Uphold organizational values by demonstrating integrity, accountability, and a commitment to exceptional service.
Additional Responsibilities
Assist with special projects, outbound campaigns, or team initiatives as assigned.
Support Workforce Management needs by adhering to schedule expectations and communicating exceptions promptly.
Participate in training refreshers, skill‑building sessions, and ongoing learning to maintain high competency levels.
Leadership & Culture
Model and reinforce organizational values of honesty, respect, empathy, innovation, uplift, and ownership, fostering a positive and inclusive team culture.
Maintain strong working relationships with peers, managers, and cross‑functional partners to support a cohesive, collaborative environment.
Qualifications:
Required:
High School Diploma or equivalent
Core Values & Professional Attributes
Demonstrates honesty, integrity, and ethical decision‑making
Shows respect and professionalism in all interactions
Strong empathy and active listening skills when supporting members and providers
Accountability and ownership of tasks, follow‑up, and outcomes
Innovative mindset with willingness to suggest improvements
Positive attitude that uplifts team environment and contributes to a supportive culture
Technical Skills
Strong technical aptitude with the ability to learn and navigate multiple PBM platforms and call center systems
Ability to work efficiently across dual monitors and manage multiple applications in real time
Proficiency in Microsoft Office Suite, especially Outlook, Excel, Word (basic use)
Skilled at researching and resolving benefit, claim, and pharmacy‑related issues during live calls
Experience & Performance
Proven reliability with strong attendance and schedule adherence
Track record of success in customer service, contact center roles, or healthcare operations
PBM or pharmacy benefit experience preferred (claims, formulary, prior authorization, plan design)
Strong verbal and written communication with the ability to explain complex benefit information clearly
High attention to detail and commitment to documentation accuracy and HIPAA compliance
Preferred:
Experience working in a Contact Center
PBM or healthcare experience
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