FairosRx Member Advocate (Hybrid or Remote)

The OccuNet Company is an innovative company striving to reduce the cost of healthcare. We are a passionate group of people that care about affordable access to healthcare without sacrificing experience. We strive to make healthcare more intelligent, streamlined, and cost-effective. We offer industry-leading capabilities on negotiations-driven levers to contain rising healthcare costs while taking an experience-centric approach improving the health and well-being of those we serve.

We pride ourselves on our tight knit culture based on the ‘outward mindset’ philosophy, emphasizing empathy, mutual respect, and seeing each other as “whole people.” We have an ambitious vision and are growing quickly. We are seeking team members who are excited about our growth, seeking to thrive in a fast-paced environment, and enthusiastic about developing their skills and career alongside us.

Job Title

: FairosRx Member Advocate

Job Summary

: Member Advocates interact with members, pharmacies, and physicians to provide accurate information and support related to pharmacy benefits. This role handles inquiries received by phone, chat, and email, ensuring each interaction is addressed with clarity, professionalism, and compassion. The Member Advocate assists with benefit questions, claim issues, medication access challenges, and helps deliver a seamless and positive pharmacy benefit experience.

About The OccuNet Company (TOC)

: The OccuNet Company is an innovative company striving to reduce the cost of healthcare. We are a passionate group of people that care about affordable access to healthcare without sacrificing experience. We strive to make healthcare more intelligent, streamlined, and cost-effective. We offer industry-leading capabilities on negotiations-driven levers to contain rising healthcare costs while taking an experience-centric approach to improving the health and well-being of those we serve.

We pride ourselves on our tight knit culture based on the ‘outward mindset’ philosophy, emphasizing empathy, mutual respect, and seeing each other as “whole people.” We have an ambitious vision and are growing quickly. We are seeking team members who are excited about our growth, seeking to thrive in a fast-paced environment, and enthusiastic about developing their skills and career alongside us.

What it’s Like to Work Here

: At OccuNet, you matter like we matter!  Our team members share a positive attitude, an outward mindset, problem-solving abilities, and patience, enabling them to provide excellent customer service even during challenging situations. Our culture, plus continuous opportunities for growth, has resulted in an industry-low turnover rate. Don’t miss out on this rare opening with us!

A Day in the Life

• : As a Member Advocate, you play a vital role in each member’s healthcare journey. Support is provided to members, pharmacies, and physicians by answering questions about pharmacy benefits, medication coverage, and available programs. You collaborate with cross-functional teams, including Clinical, Account Management, Operations and other internal departments, to research and resolve complex issues, ensuring timely resolution and appropriate follow-up.
• Success in this role is driven by combining strong problem-solving skills, attention to detail, empathy, and a genuine passion for helping others. Through every interaction, you help remove barriers to care and improve the member experience.
• Duties & Responsibilities: Provide clear, empathetic assistance to members regarding pharmacy benefits, formulary coverage, copays, prior authorizations, and medication access.
• Support pharmacies in resolving claim processing questions or issues.
• Work with providers to assist with prior authorizations and drug coverage information.
• Identify claims requiring action, initiate outbound outreach, and resolve issues efficiently.
• Handle complex or sensitive cases with professionalism and follow escalation pathways when needed.
• Proactively identify issues, determine resolution, and communicate appropriately.
• Demonstrate strong knowledge, confidence, empathy, soft skills, and offer post‑call surveys to support continuous improvement of the member experience.
• Verify required data elements on every interaction and adhere to HIPAA and internal privacy policies.
• Navigate software, applications, and PBM tools accurately and efficiently.
• Document all interactions through the ticketing system according to the procedures set by the department.
• Engage in call quality reviews, incorporate feedback, and apply coaching to improve performance.
• Adhere to all organizational and departmental procedures.
• Participate in team discussions and activities with an outward, collaborative mindset.
• Support additional tasks as needed to meet organizational goals.
• Required Skills and Abilities: 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.
• Demonstrates teamwork by collaborating effectively with peers and cross-functional teams to support member needs.
• 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.