Customer Service Representative

Therapeutic Solutions is seeking a Call Center Representative to provide remote customer service support to members in California. The role handles inquiries about pharmacy benefits, claims, eligibility, billing, and related services, resolves complaints, documents interactions, and escalates unresolved concerns in a high-volume call center environment.

Responsibilities:

• The main function of a Member Service Representative is to interact with customers to provide information in response to inquiries about products and services and to handle and resolve complaints. A typical Representative is responsible for determining the client's issue, offering possible solutions, or providing follow-up as needed. Customer service representatives may handle inbound, outbound, or blended calls
• Resolve customer service or billing complaints by processing account adjustments, refunds, or other appropriate resolutions
• Respond to customer inquiries regarding pharmacy benefits, claims, eligibility, billing, and related services
• Contact customers regarding claim investigation results and planned adjustments
• Escalate unresolved customer concerns to the appropriate departments
• Accurately document customer interactions, inquiries, complaints, and resolutions
• Navigate multiple computer systems while maintaining productivity and accuracy
• Meet quality, productivity, and customer satisfaction expectations in a high-volume call center environment

Requirements:

• High school diploma or GED required
• 0–2 years of customer service experience required
• High-volume call center/customer service experience required
• Previous experience using MS Outlook, data entry applications, and multiple computer systems
• Proficiency navigating dual monitors and multiple software applications simultaneously
• Ability to accurately document customer information
• Strong critical thinking, problem-solving, and conflict resolution skills
• Excellent verbal and written communication skills
• Ability to work independently in a remote environment
• Ability to maintain confidentiality while handling protected health information (PHI)
• Healthcare or pharmacy call center experience is strongly preferred
• Spanish bilingual preferred
• Pharmacy or healthcare customer service experience
• Experience supporting Medicare, Medicaid, or health insurance members