As a Member Experience Coordinator, you will serve as the primary voice of our organization, delivering compassionate, high-touch support to our plan members. Navigating pharmacy benefits can be stressful and complex; in this role, you will act as a trusted advocate, guiding members through their coverage details, demystifying out-of-pocket costs, and championing proactive solutions.

Working at the intersection of customer care, clinical strategy, and pharmacy operations, you will resolve intricate benefit challenges and build lasting trust with the communities we serve.

Key Responsibilities

• Frontline Member Advocacy & Support: Serve as the initial point of contact for inbound member inquiries via phone, email, and secure messaging. Provide empathetic, clear, and actionable guidance regarding prescription benefits, copay tiers, prior authorizations, and formulary options.

• Proactive Outreach & Education: Conduct outbound communication to support clinical initiatives, medication adherence programs, and wellness campaigns. Help members identify cost-saving opportunities and navigate benefit transitions before hurdles arise.

• Cross-Functional Issue Resolution: Act as a central liaison between members and internal multidisciplinary teams (Clinical Care, Pharmacy Operations, Data Analytics, and Network Management) to resolve escalations, claims disputes, and coverage barriers.

• Regulatory Compliance & Data Integrity: Maintain strict compliance with HIPAA, state board regulations, and CMS guidelines. Accurately document member interactions, cases, and resolution notes within our care coordination systems.

• Continuous Improvement: Identify recurring friction points or process inefficiencies within the member journey and partner with leadership to implement process enhancements.

Qualifications & Experience

Minimum Qualifications:

• High School Diploma or GED equivalent.

• 1+ years of customer service or support experience in healthcare operations, health insurance/PBMs, care coordination, or a high-volume healthcare call center environment.

• Proven ability to explain complex benefit structures, clinical workflows, or financial terms in plain, compassionate language.

• High degree of emotional intelligence, patience, and active listening skills.

• Thorough understanding of patient privacy regulations and HIPAA compliance standards.

• Strong digital literacy with experience navigating electronic health records (EHR), CRM platforms, or benefits databases.

Preferred Qualifications:

• Active Certified Pharmacy Technician (CPhT) credential through the PTCB or NHA (or the commitment to obtain certification within 6 months of hire).

• Prior experience in retail pharmacy, specialty pharmacy, or pharmacy benefit operations.

• Bilingual proficiency (English/Spanish or other languages).
  

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients