Customer Service Representative

Job Description

Job Description

We are looking for a Customer Service Representative to support members and prospective members with pharmacy benefit questions in Westminster, California. This Long-term Contract position is ideal for someone who thrives in a fast-paced call center setting and is committed to delivering accurate, compassionate service. The person in this role will handle benefit-related inquiries, coordinate refill support with network pharmacies, and ensure each interaction is documented thoroughly while meeting healthcare compliance standards.

Responsibilities:
• Respond to inbound member and prospective member inquiries related to pharmacy benefits, coverage details, and service options.
• Provide assistance with prescription refill coordination by working with approved pharmacy partners when additional support is needed.
• Escalate medication-related or clinical issues to appropriate clinical leadership for review and follow-up.
• Partner with internal teams focused on medication adherence to support outreach efforts and help improve member outcomes.
• Participate in assigned calling campaigns designed to enhance member service and strengthen engagement.
• Follow established procedures, reference materials, and departmental guidelines to complete work accurately and efficiently.
• Identify workflow challenges, communicate improvement ideas to management, and report operational issues through proper channels.
• Record member interactions, actions taken, and required follow-up in designated systems according to documentation standards.
• Attend team meetings, training sessions, and ongoing coaching activities to maintain service quality and performance expectations.
• Comply with all applicable federal, state, and organizational regulations, policies, and operational requirements.• At least 2 years of experience in customer service, preferably in a call center or healthcare support environment.
• Ability to manage inbound and outbound calls professionally while delivering clear and empathetic service.
• Experience handling customer inquiries, service requests, and order-related transactions with strong attention to detail.
• Comfortable working in an environment that emphasizes continuous coaching, performance feedback, and ongoing development.
• Strong written and verbal communication skills with the ability to explain benefit information clearly.
• Proficiency in documenting interactions accurately within computer systems and following established procedures.
• Ability to prioritize tasks, solve problems efficiently, and maintain compliance with regulated processes.