Membership Service Advocate – OTC (S2)

About the role

As a Membership Service Advocate (OTC – S2) you will join Helpware’s customer experience team to provide high-quality support to health plan beneficiaries. You will help members update their account details, understand their benefits and resolve billing or prescription issues, ensuring a seamless and caring experience.

Key responsibilities

• Update member account information such as billing options, address or phone changes.
• Research premium billing discrepancies and prescription claim details.
• Educate beneficiaries on plan benefits, cost-sharing, coverage levels and formulary tiers.
• Process mail requests for ID cards, formularies and other member documents.
• Verify medication coverage on the formulary and explain non-coverage reasons.
• Handle inbound and outbound calls with accuracy and efficiency.
• Maintain detailed, concise notes in member records and ensure HIPAA compliance.
• Escalate complex member issues to management when needed.
• Follow CMS guidance for mailing exhibits and adhere to all company policies.

Required profile

• Strong desire to help people with excellent customer-care orientation.
• High attention to detail and strong organizational skills.
• Positive demeanor and professional communication style.
• Ability to work accurately under established policies and regulatory requirements (HIPAA, CMS).

Required skills