Customer Service Representative PBM

Marpai Administrators LLC

Raleigh, NC(remote)

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JOB DETAILS

SKILLS

Artificial Intelligence (AI), Broadband, Budget Management, Check Processing, Claims Processing, Co-Payments, Communication Skills, Customer Relationship Management (CRM) Systems, Customer Service Management, Customer Support/Service, Deep Learning, Detail Oriented, Documentation, Flexible Spending Accounts, Formulary, HIPAA (Health Insurance Portability and Accountability Act), Health Plan, Healthcare, Healthcare Providers, High School Diploma, Insurance, Insurance Claims, Machine Learning, Medical Billing, Multiplatform/Cross-Platform, Pharmacy, Prescription Drugs, Presentation/Verbal Skills, Problem Solving Skills, Quality Metrics, Resolve Customer Issues, Risk

LOCATION

Raleigh, NC

POSTED

5 days ago

Marpai Administrators (Subsidiary of Marpai Inc. (NASDAQ: MRAI)) is a technology company transforming the Third Party Administration sector serving employers with self-funded health plans. Marpai Administrators (“Marpai”) is an AI-powered national TPA (third party administrator) using deep learning and machine learning to maximize population health outcomes with the greatest cost efficiency for any health plan budget. We create healthier members and a healthier bottom line. Marpai proactively targets at-risk members with meaningful clinical interventions to improve outcomes.

ABOUT THE POSITION:
The Customer Service Representative (CSR) reports to the Customer Service Supervisor to help healthcare providers and members with prescription and insurance questions. The CSR must maintain positive, empathetic, and professional attitude through verbal or written communication.

WHAT YOU WILL BE DOING:

Member Support: Answer inquiries regarding drug formularies, copays, deductibles, network pharmacies, and prescription benefit coverage.
Pharmacy & Provider Coordination: Assist network pharmacies with claims processing, eligibility checks, and securing prior authorizations.
Problem Resolution: Investigate and resolve complaints or coverage rejections, ensuring first-call resolution while maintaining empathy.
Documentation & Compliance: Accurately log call details in CRM and ticketing systems while strictly adhering to HIPAA privacy standards.
Quality & Metrics: Meet call-center performance standards, such as Average Handle Time (AHT) and Schedule Adherence.
Other duties as required

WHAT DO YOU NEED:

High school diploma or GED required; associate or bachelor’s degree preferred.
Strong customer service and communication skills
Ability to navigate multiple software platforms simultaneously.
Active listening, problem-solving, and ability to deescalate stressful situations.
Attention to detail and accuracy
Ability to maintain confidentiality

PREFERED EXPERIENCE:

1–2 years of customer service experience in healthcare or pharmacy setting
Experience handling insurance claims or medical billing preferred
State issued pharmacy technician registration preferred.

WORK REQUIREMENTS:

100% Remote
Flexibility to work 8 am – 8 pm
Must have high speed internet connection
Must have professional, confidential, isolated work area.
This position is in a typical office environment that requires prolonged sitting in front of a computer.

WHY WORK AT MARPAI?

We have great benefits:

Generous PTO
Medical and Prescription
Health and Wellness Programs
EAP
FSA / HSA / Dependent Care
Dental
Vision
Life and Disability
STD/LTD
Voluntary Benefits: Critical Illness, Accident, Hospital
401k with Employer Match
LegalShield
Identity Theft Protection

Marpai is an equal opportunity workplace. We are committed to equal opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, or veteran status.

Customer Service Representative PBM

Marpai Administrators LLC

Raleigh, NC(remote)

About the Company

Marpai Administrators LLC

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