Member Services Specialist – Medication Access & Support Programs

Maven is seeking a Member Services Specialist to support members in a new, fast growing care program involving complex GLP-1 medication access, pharmacy coordination, and sensitive chronic condition support. This role blends high volume omni channel support with deeper insurance and pharmacy navigation to ensure members receive clear guidance, timely medication access, and a compassionate experience throughout their treatment journey.

You will help members understand benefit requirements, coordinate with partner pharmacies, resolve fulfillment issues, and navigate sensitive health conversations with care. You’ll also work closely with clinical operations, pharmacy partners, and internal teams to reduce friction and improve the GLP-1 medication access process.

This role is ideal for someone who enjoys problem solving across multiple systems, thrives in a fast paced queue-oriented environment, and has experience supporting programs involving high demand, tightly regulated, or insurance intensive medications.

Our Member Services team works remotely and supports Maven members 7 days/week. We are currently hiring for the following shifts:

• Mon–Fri 8:30 AM – 5:00 PM
• Mon–Fri 1:00 PM – 9:30 PM
• Sun–Thurs 8:30 AM – 5:00 PM (Sun: 9:00 AM – 5:30 PM)
• Tues–Sat 8:30 AM – 5:00 PM (Sat: 9:00 AM – 5:30 PM)

What You’ll Do

Member & Pharmacy Support

• Assist members via live chat, messaging, and phone with program steps, timelines, and medication fulfillment questions around G1P-1 medications.
• Triage inbound pharmacy calls regarding missing information, clarification requests, coverage issues, or inventory/shipping challenges.
• Place outbound calls to verify prescription status, coordinate refills, resolve fulfillment issues, and confirm delivery details.
• Set accurate expectations around review processes, benefit checks, and pharmacy workflows.

Insurance, Coverage & Benefits Navigation

• Collect, verify, and interpret insurance information related to medication access.
• Check eligibility, coverage criteria, formulary placement, and potential costs using internal tools and payer portals.
• Identify barriers such as step therapy, clinical documentation needs, or quantity limits, and guide members through next steps.
• Support prior authorization workflows by gathering required details and explaining process expectations.

Medication Access & Issue Resolution

• Navigate the full non clinical access process from prescription initiation → coverage determination → fulfillment → delivery.
• Identify and resolve common pharmacy rejects or benefit issues.
• Prioritize time sensitive matters such as fulfillment delays or urgent pharmacy requests.
• Escalate potential safety concerns or clinical red flags to the appropriate team.

Member Experience & Sensitive Communication

• Offer empathetic, stigma free support on chronic conditions and medication related topics.
• De escalate member frustration related to delays, cost, or benefit denials.
• Communicate complex steps clearly and help members feel informed and supported.

Documentation, Quality & Continuous Improvement

• Document interactions accurately and completely.
• Contribute to internal SOPs, scripts, and knowledge articles as workflows evolve.
• Surface trends or recurring friction points to operations and product partners.
• Meet or exceed metrics including response time, quality, and member satisfaction.

Compliance & Risk Management

• Follow all PHI, privacy, eligibility verification, and non clinical scope protocols.
• Support fraud prevention workflows related to high demand medications.
• Provide guidance aligned with regulatory and internal requirements.

Qualifications

• 2+ years of member-facing experience in customer support, specifically within the fertility benefits, healthcare, or insurance space
• Strong understanding of insurance processes, including benefits structures and medical claims workflows
• Experience with claims processing and reimbursement, including reviewing documentation and supporting payment resolution
• Meticulous attention to detail
• Strong customer service orientation
• High degree of empathy in dealing with sensitive topics
• Proficient in Google Workspace tools & Zendesk
• Ability to work independently and as part of a team
• Strong organizational skills; demonstrated ability to multi-task and manage time effectively
• Strong written and verbal communication skills
• Experience supporting specialty GLP-1 medications, chronic condition programs, or medications requiring intensive insurance steps.
• Familiarity with prior authorizations, pharmacy rejects, benefit investigations, or medication fulfillment processes.
• Experience with Zendesk or other CX tools,
• Experience coordinating with pharmacies, prescribers, or clinical operations teams.
• Fluency in Spanish or another language commonly spoken by members.
• Bachelor’s degree or equivalent work experience.