Member Services Specialist – Medication Access & Support Programs

3+ years of member-facing experience in customer support, specifically within the fertility benefits, healthcare, or insurance space. Strong understanding of insurance processes, including benefits structures and medical claims workflows. Experience with claims processing and reimbursement. Meticulous attention to detail. Strong customer service orientation. High degree of empathy in dealing with sensitive topics. Proficient in Google Workspace tools & Zendesk. Ability to work independently and as part of a team. Strong organizational skills; demonstrated ability to multi-task and manage time effectively. Strong written and verbal communication skills. Experience supporting specialty GLP-1 medications, chronic condition programs, or medications requiring intensive insurance steps. Familiarity with prior authorizations, pharmacy rejects, benefit investigations, or medication fulfillment processes. Experience with Zendesk or other CX tools. Experience coordinating with pharmacies, prescribers, or clinical operations teams. Fluency in Spanish or another language commonly spoken by members. Bachelor’s degree or equivalent work experience.

Assist members via live chat, messaging, and phone with medication fulfillment questions. Triage inbound pharmacy calls regarding missing information, clarification requests, or coverage issues. Place outbound calls to verify prescription status, coordinate refills, and resolve fulfillment issues. Collect, verify, and interpret insurance information and check eligibility, coverage, and costs. Support prior authorization workflows. Navigate the non-clinical access process from prescription initiation to delivery. Resolve pharmacy rejects or benefit issues. Offer empathetic, stigma-free support on chronic conditions and medication related topics. De-escalate member frustration. Document interactions accurately and contribute to internal SOPs. Follow all PHI, privacy, and eligibility verification protocols. Support fraud prevention workflows.