Customer Service Representative

Job Description

Job Description

We are looking for a bilingual Vietnamese and English Customer Service Representative to support members with pharmacy benefit questions and service needs in Westminster, California. This Contract position is ideal for someone who enjoys helping people over the phone, resolving issues with care, and maintaining accurate records in a fast-paced healthcare environment. The person in this role will serve as a key point of contact for pharmacy-related concerns while working closely with internal teams to deliver responsive, compliant member support.

Responsibilities:

• Respond to inbound member and prospective member inquiries related to pharmacy benefits, coverage details, and general service questions.

• Coordinate with network pharmacies to help members address refill needs and related access issues when additional support is required.

• Escalate clinical questions or sensitive medication concerns to the appropriate clinical leaders for timely review and follow-up.

• Partner with internal quality and performance teams to support programs focused on improving medication adherence outcomes.

• Participate in outbound calling initiatives assigned by leadership to strengthen member engagement and service delivery goals.

• Follow established procedures, reference materials, and operational guidelines to handle requests accurately and efficiently while identifying workflow concerns to management.

• Maintain complete and accurate documentation of member interactions, actions taken, and required forms within designated systems according to department standards.

• Attend team meetings, training sessions, and coaching activities, and apply feedback to improve service quality and performance.

• Adhere to all applicable federal, state, and organizational compliance requirements related to health plan operations.

• Perform additional customer service and administrative duties as needed to support department objectives.

• At least 2 years of experience in customer service, preferably in a call center or healthcare-related setting.
• Experience handling inbound and outbound calls while providing clear, attentive support to customers or members.
• Working knowledge of order entry, transaction documentation, and maintaining accurate records in computer-based systems.
• Strong communication skills with the ability to explain pharmacy benefit information in a clear and helpful manner.
• Ability to manage multiple tasks efficiently while following established procedures and compliance guidelines.
• Comfortable working in an environment that emphasizes ongoing coaching, feedback, and continuous improvement.
• Strong problem-solving skills and sound judgment when identifying issues that require escalation.
• High school diploma or equivalent required; additional healthcare or customer service training is a plus.