Maven Clinic · 2 weeks ago
Member Services Specialist – Medication Access & Support Programs
United States
Full-time
Remote
Entry, Mid Level
2+ years expMaven is the world's largest virtual clinic for women and families, and they are seeking a Member Services Specialist to support members in a new care program involving complex medication access. This role involves providing high-volume support, navigating insurance and pharmacy processes, and ensuring a compassionate experience for members throughout their treatment journey.
FamilyHealth CaremHealthWomen's
Responsibilities
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
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
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
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
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
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
Qualification
Required
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
Preferred
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
Benefits
Maven for Mavens: access to the full platform and specialists, including care for mental health, reproductive health, family planning and pediatrics.
Whole-self care through wellness partnerships
Hybrid work, in office meals, and work together days
16 weeks 100% paid parental leave and new parent stipend (for Mavens who've been with us for 1 year+)
Annual professional development stipend and access to a personal career coach through Maven for Mavens
401K matching for US-based employees, with immediate vesting
Company
Maven Clinic
Maven is a digital health platform that works with health plans and employers to offer virtual services for women’s and family health.
201-500 employees
Funding
Current Stage
Late StageTotal Funding
$417.1MKey Investors
StepStone GroupGeneral CatalystIcon Ventures
2024-10-08Series F· $125M
2022-11-14Series E· $90M
2021-08-17Series D· $110M
Leadership Team
Kate Ryder
Founder & CEO
Julia Marley-Rappoport
VP, Strategic Finance
Recent News
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