We are looking for a Customer Service Representative to support members with pharmacy benefit questions and service needs for a Contract position based in Westminster, California. In this role, you will deliver responsive assistance by phone, help coordinate refill-related requests with network pharmacies, and ensure each interaction is documented accurately. This opportunity is well suited for someone who thrives in a call center setting, communicates clearly, and can balance service excellence with regulatory compliance.
Responsibilities:
- Respond to incoming member and prospective member inquiries related to pharmacy benefits, coverage, and general service support.
- Assist with prescription refill coordination by working with network pharmacies when additional support is needed.
- Escalate clinical questions or sensitive medication-related concerns to the appropriate clinical leadership team.
- Partner with internal teams focused on medication adherence initiatives to support quality and member engagement goals.
- Participate in outbound and inbound calling campaigns assigned by leadership to enhance the overall member experience.
- Record member interactions thoroughly in designated systems, including actions taken, follow-up needs, and required forms.
- Follow established workflows, job aids, and operating procedures while identifying opportunities to improve efficiency and service quality.
- Maintain compliance with applicable federal, state, and organizational requirements governing health plan operations.
- Engage constructively in coaching, training sessions, and team meetings to strengthen performance and service delivery.
- Provide additional administrative or service-related support as assigned by management.
- At least 2 years of experience in customer service, preferably in a call center or member support environment.
- Background handling inbound and outbound calls with a detail-focused and service-oriented approach.
- Experience addressing customer questions, resolving issues, and entering accurate information into internal systems.
- Ability to explain pharmacy-related benefits or similar healthcare information in a clear and understandable manner.
- Strong documentation skills with close attention to detail and accuracy.
- Comfortable working in an environment that emphasizes continuous feedback, coaching, and performance improvement.
- Working knowledge of compliance expectations and confidentiality standards in a regulated setting.
- Effective communication and collaboration skills, with the ability to escalate issues appropriately when needed.