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.
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.
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.
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.
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.