Member Advocate - FairosRx (Hybrid)

The OccuNet Company is an innovative company striving to reduce the cost of healthcare. We are a passionate group of people that care about affordable access to healthcare without sacrificing experience. We strive to make healthcare more intelligent, streamlined, and cost-effective. We offer industry-leading capabilities on negotiations-driven levers to contain rising healthcare costs while taking an experience-centric approach improving the health and well-being of those we serve. We pride ourselves on our tight knit culture based on the ‘outward mindset’ philosophy, emphasizing empathy, mutual respect, and seeing each other as “whole people.” We have an ambitious vision and are growing quickly. We are seeking team members who are excited about our growth, seeking to thrive in a fast-paced environment, and enthusiastic about developing their skills and career alongside us. 

Fairosrx Member Advocate

Job Summary:  As a Member Advocate, you will serve at the forefront of The OccuNet Company’s experience-centric approach, improving the health and well-being of members.  You will utilize your interpersonal abilities to provide callers with exceptional support by delivering high-quality, professional, and efficient service across multiple channels.  You will communicate with members, clients, providers, and third parties to resolve inquiries related to prescription benefits.

What it’s Like to Work Here:  At The OccuNet Company, you matter like we matter!  Our team members share a positive attitude, an outward mindset, problem-solving abilities, and patience, enabling them to provide excellent customer service even during challenging situations. Our culture, plus continuous opportunities for growth, has resulted in an industry-low turnover rate. Don’t miss out on this rare opening with us!

A Day in the Life: The Member Advocate is responsible for phone and written interactions related to prescription benefits for the FairosRx line of business. Phone inquiries include prescription benefit education such as drug coverage, copays, deductibles, out-of-pocket responsibility, prior authorizations, pharmacy network, and claim-related questions. Member Advocates are responsible for providing callers with timely communication related to their pharmacy benefit inquiries and will initiate follow-up calls at the appropriate service level agreement standards. The advocates are also responsible for making outbound calls to providers, clients, members, and pharmacies to gather appropriate information or submit requests as needed to reach a timely resolution. Member Advocates attend various meetings and training sessions to stay fully capable and up to date on job roles and responsibilities.

Duties And Responsibilities:

• Responsible for accurate, concise, timely, and personable responses to interactions via telephone or electronically.
• Advocate for members and clients by actively listening, providing information, and offering solutions.
• Provide exceptional service and go above and beyond to educate and present solutions to callers.
• Assist pharmacies with claims processing.
• Work with providers to assist with prior authorizations and drug coverage information.
• Monitor rejected claims, identify rejects requiring action, and make outbound calls to resolve issues.
• Escalate issues when appropriate.
• Proactively identify issues, determine resolution, and communicate appropriately.
• Ensure call quality by applying the following skills: knowledge, confidence, exceptional caller experience, empathy, sympathy, soft skills, and offering post-call surveys.
• Maintain confidentiality of sensitive information by verifying three data elements on all calls and adhering to corporate and departmental HIPAA policies and procedures.
• Utilize software, applications, and tools appropriately.
• Document all interactions through the ticketing system according to the procedures set by the department.
• Actively participate in coaching sessions, receive feedback, and make appropriate adjustments.
• Meet individual adherence and call performance metric expectations.
• Follow departmental policies and procedures.
• Participates in team discussions and activities with an outward mindset.
• Perform other duties as assigned.

Required Skills And Abilities:

• Team-first mindset with a high level of motivation and drive.
• Naturally compassionate and easily able to navigate sensitive, challenging situations with care.
• Passionate and proactive about contributing to organizational missions focused on improving member experiences.
• Persistent with a drive to see tasks through with a high standard for attention to detail.
• Ability to multi-task and work in a fast-paced environment.
• Demonstrate proficient computer skills.
• Ability to work a flexible schedule, including but not limited to weekends and holidays.

Education And Experience:

• High school diploma or equivalent required.
• Call center experience preferred.
• PBM experience preferred.

Culture And Opportunities

• We pride ourselves on our outward mindset – supporting each other and putting the team and the clients we serve first
• High-growth environment with clear opportunities for career growth
• Welcoming atmosphere and culture

Benefits

• 401(k) with matching
• Dental insurance
• Health insurance
• Vision insurance
• Health savings account
• Paid time off