Member Advocate

🔥 19 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The OccuNet Company

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1998

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

The OccuNet Company is a privately owned healthcare services firm focused on improving healthcare affordability and member experience through integrated, transparent solutions. It offers services including out-of-network negotiation, reference-based pricing, bill review, medical contract negotiations, and pharmacy benefit management, supported by its OnPoint technology platform and member advocacy teams. The company serves employers, payers, TPAs, health plans, brokers, and providers, emphasizing cost-efficiency, compassionate member support, and tech-enabled administration.

📋 Description

• Interact with members, pharmacies, and physicians regarding pharmacy benefits • Handle inquiries by phone, chat, and email • Provide assistance with formulary coverage, copays, prior authorizations, and medication access • Support pharmacies with claim processing questions and issues • Assist providers with prior authorizations and drug coverage information • Identify claims requiring action, conduct outbound outreach, and resolve issues • Handle complex or sensitive cases and follow escalation pathways • Collaborate with Clinical, Account Management, Operations, and other internal teams • Verify required data elements and adhere to HIPAA and internal privacy policies • Navigate software, applications, and PBM tools • Document interactions in the ticketing system • Participate in call quality reviews, apply coaching, and support continuous improvement • Participate in team discussions and perform additional tasks as needed

🎯 Requirements

• High school diploma or equivalent required • Previous experience in pharmacy benefit management (PBM) is strongly preferred; pharmacy technician, healthcare, insurance, customer service, or call center experience highly valued • Member-focused mindset with a passion for improving the member experience • Highly effective verbal and written communication skills • Ability to collaborate effectively with peers and cross-functional teams • Strong computer skills, including Microsoft Office, with the ability to quickly learn new systems and technology • Ability to multitask, manage time efficiently, and stay organized in a fast-paced, high-volume environment • Excellent active listening, problem solving, and critical thinking skills • Ability to work Monday to Friday, 12:00 PM–9:00 PM CST

🏖️ Benefits

• 401(k) with matching • Dental insurance • Health insurance • Vision insurance • Health savings account • Paid time off • High-growth environment with clear opportunities for career growth • Welcoming atmosphere and culture