Member Services Team Lead – Medication Access & Support Programs

Responsibilities

• Own real time execution during assigned shifts across chat and phone queues.
• Monitor queue health, coverage, and workload distribution to ensure timely responses.
• Step in directly to handle complex cases or volume spikes as needed.
• Serve as day to day support for a team of Member Services Associates.
• Provide real time coaching on judgment calls, prioritization, and handling ambiguous cases where no clear script exists.
• Conduct quality reviews and deliver clear, actionable feedback.
• Support onboarding and ramping of new hires.
• Act as the first line escalation point for pharmacy and insurance issues including missing information, coverage rejects, routing questions, and fulfillment delays.
• Partner with internal teams to resolve escalated member issues while maintaining non clinical boundaries.
• Ensure appropriate handling and escalation of safety concerns or sensitive disclosures.
• Ensure consistent execution of SOPs, scripts, and workflows.
• Identify breakdowns in workflows and flag patterns or risks to leadership.
• Help test, roll out, and reinforce new workflows, macros, or tooling changes.
• Support team performance across response time, resolution quality, and member satisfaction.

Core Competencies

Demonstrates expertise in healthcare support and pharmacy operations, with a strong focus on coaching and mentoring team members. Proficient in managing escalations and ensuring adherence to workflows and quality standards.

Requirements

• 2–4 years of experience in healthcare support, pharmacy operations, insurance navigation, or related fields.
• Prior experience coaching, mentoring, or acting as a senior or lead in a frontline environment.
• Strong understanding of pharmacy workflows, insurance coverage concepts, and medication access processes.
• Comfort handling escalations and emotionally charged member situations.
• Strong written and verbal communication skills.
• Ability to balance hands-on work with people leadership.
• Experience supporting specialty or high demand medications.
• Experience with Zendesk highly preferred or other CX tools.
• Familiarity with QA frameworks and support performance metrics.
• Experience helping teams adopt new tools or workflows.
• Fluency in Spanish or another commonly spoken member language.