Member Advocate

Position Summary

The Member Advocate I serves as a frontline representative, providing exceptional support and education to members in a fast-paced remote call center environment. This role is responsible for managing the general queue, responding to "Contact Us" requests, and delivering accurate, empathetic, and timely solutions. By ensuring a positive member experience through excellent service, clear communication, and efficient time management, the Member Advocate I plays a key role in building trust and satisfaction with our organization.

Key Responsibilities

• Manage an average of 40+ inbound calls daily from the general queue, providing professional and empathetic support.

• Respond to "Contact Us" submissions through the website within established service-level agreements.

• Accurately document all interactions and resolutions in the system.

• Navigate multiple systems and resources to troubleshoot and resolve member concerns in real time.

• Educate members on plan benefits, coverage, and processes to promote understanding and empowerment.

• Guide members through prior authorization, formulary exceptions, and appeal procedures as needed.

• Escalate complex issues to appropriate teams while maintaining ownership of the member experience.

• Actively participate in team huddles, training sessions, and performance reviews.

• Share feedback and insights to support continuous improvement in workflows and member satisfaction.

• Ensure compliance with privacy regulations, internal protocols, and quality standards.

• Perform additional duties as assigned to support departmental and organizational goals.

Required Qualifications

• 1+ years of experience in member services or healthcare operations, preferably in pharmacy benefits or managed care.

• Proficiency with Contact Center as a Service (CCaaS) platforms, Microsoft Office, and CRM systems.

• Demonstrated ability to manage task queues and synopsis requests with accuracy and follow-through.

• Comfort navigating complex workflows such as prior authorization, formulary exclusions, and appeals.

Preferred Qualifications

• Advanced experience with CCaaS and CRM platforms.

• Familiarity with compliance and quality assurance standards in member-facing roles.

• Proficiency in claims processing and rejection resolution, with knowledge of pharmacy systems and tools (e.g., Tritium, Five9).

• Experience handling escalated member concerns with professionalism and accuracy.

• Strong collaboration skills, with proven ability to work effectively across teams and with leadership.

What We Offer

At DisclosedRx, we are committed to supporting our employees' growth and well-being. As a Member Advocate I, you will have access to:

• Comprehensive Benefits Package – Including medical, dental, vision, and life insurance.

• Paid Time Off & Holidays – PTO and company-observed holidays to support work-life balance.

• Professional Growth Opportunities – Ongoing training, career development, and the ability to grow into advanced roles.

• Remote Work Flexibility – Work from the comfort of your home with the tools and support you need to succeed.

• Collaborative Culture – Be part of a supportive, mission-driven team that values communication, accountability, and innovation.