Seasoned Pharmacy Customer Service Representative – Remote, New Mexico – Deliver Exceptional Member Care at brighthush

About brighthush and the Pharmacy Customer Service Role

brighthush is a leading provider of integrated health solutions, dedicated to improving the lives of members across the United States. With a focus on innovation, quality, and cost‑effective care, brighthush partners with providers, pharmacies, and members to streamline medication management and enhance health outcomes. Our pharmacy customer service team is the frontline of this mission, ensuring that every call, every request, and every interaction reflects our commitment to excellence.

We are seeking a highly motivated Pharmacy Customer Service Representative to join our remote team from New Mexico. This role is pivotal in delivering seamless support for inbound and outbound pharmacy calls, coordinating prior authorizations, and ensuring compliance with state regulations, NCQA guidelines, and CMS standards. If you thrive in a fast‑paced environment, enjoy problem‑solving, and are passionate about improving member experience, we want to hear from you.

Key Responsibilities

• Handle Inbound & Outbound Calls: Manage pharmacy calls from members, providers, and pharmacies, ensuring accurate documentation in our call tracking system.
• Prior Authorization & Appeals: Process pharmacy prior authorization requests, assist with appeals, and provide clear guidance on coverage determinations.
• Policy & Benefit Communication: Explain point‑of‑sale claims adjudication, formulary information, copay amounts, and pharmacy location services to members and providers.
• Clerical & Operational Support: Perform day‑to‑day call center tasks, including data entry, case preparation, and coordination with pharmacists for comprehensive medication reviews (CMRs).
• Quality & Compliance: Maintain established call quality and quantity standards, adhere to departmental policies, and stay current with state regulations and CMS guidelines.
• Member Registry Management: Collaborate with primary care providers to keep member registries accurate and up‑to‑date.
• Process Improvement: Identify opportunities to enhance member relations, streamline workflows, and improve overall call center efficiency.
• Special Projects: Independently manage projects such as pill box requests, case management referrals, and over‑the‑counter (OTC) requests.

Essential Qualifications

• Minimum of 1 year of relevant experience in a call center or customer service environment, or an equivalent combination of education and experience.
• Excellent customer service skills with a proven ability to handle complex inquiries with empathy and professionalism.
• Strong multitasking abilities: manage multiple applications while engaging with members.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and familiarity with pharmacy call center software.
• Exceptional verbal and written communication skills, including superior phone etiquette.
• Self‑motivated and capable of working independently on special projects and meeting deadlines.
• Ability to build and maintain positive relationships with coworkers, members, providers, regulatory agencies, and vendors.

Preferred Qualifications

• Certified Pharmacy Technician (CPhT) or state pharmacy technician license (active and unrestricted in New Mexico).
• Prior experience in the healthcare industry, particularly in pharmacy operations.
• Bilingual proficiency in Spanish – highly encouraged to serve our diverse member base.

Skills & Competencies for Success

• Customer‑Centric Mindset: Passion for delivering outstanding member experiences and resolving issues efficiently.
• Analytical Thinking: Ability to interpret policy guidelines, analyze claims data, and provide actionable insights.
• Attention to Detail: Accurate documentation and adherence to compliance standards.
• Adaptability: Comfortable with evolving processes, new technologies, and shifting priorities.
• Team Collaboration: Works effectively with pharmacists, providers, and internal stakeholders to achieve shared goals.
• Time Management: Prioritizes tasks, meets deadlines, and maintains productivity in a remote setting.

Career Growth & Learning Opportunities

At brighthush, we believe in nurturing talent and fostering continuous learning. As a Pharmacy Customer Service Representative, you will have access to:

• Structured onboarding and mentorship programs to accelerate your integration into the team.
• Regular training sessions on pharmacy regulations, NCQA standards, and CMS updates.
• Cross‑functional exposure to pharmacy operations, case management, and quality improvement initiatives.
• Clear career pathways to roles such as Pharmacy Operations Specialist, Quality Assurance Analyst, or Pharmacy Program Manager.
• Support for professional certifications, including CPhT and other pharmacy technician credentials.

Work Environment & Company Culture

brighthush champions a culture of collaboration, innovation, and respect. Our remote work model empowers employees to balance professional responsibilities with personal commitments. You will enjoy:

• Flexible scheduling within the Monday‑Friday, 11 a.m. to 7:30 p.m. MST shift.
• Access to a virtual team hub, daily stand‑ups, and real‑time collaboration tools.
• A supportive leadership team that values transparency, feedback, and employee well‑being.
• Recognition programs that celebrate achievements and milestones.
• Inclusive initiatives that promote diversity, equity, and belonging across all levels.

Compensation, Perks, and Benefits

While the hourly rate ranges from $15.40 to $26.42, actual compensation may vary based on experience, education, and skill level. In addition to competitive pay, brighthush offers:

• Comprehensive health, dental, and vision insurance plans.
• Retirement savings plan with employer matching.
• Paid time off, holidays, and flexible vacation policies.
• Employee assistance programs and wellness resources.
• Professional development budget and tuition reimbursement for relevant courses.
• Access to a robust employee resource network and community events.

Why Join brighthush?

When you become part of brighthush, you join a mission‑driven organization that places member health at the forefront of everything we do. Your work will directly influence medication access, cost savings, and overall health outcomes for thousands of members. You will be part of a team that values innovation, collaboration, and continuous improvement.

We are committed to creating an inclusive workplace where every voice is heard and every contribution matters. Whether you are a seasoned professional or just starting your career in pharmacy customer service, brighthush offers the resources, support, and opportunities to grow and thrive.

Ready to Apply?

If you are ready to make a tangible impact on member care and join a forward‑thinking organization, we encourage you to submit your application today. Bring your expertise, enthusiasm, and dedication to a role that rewards excellence and fosters professional growth.

We look forward to welcoming you to the brighthush family and working together to create brighter, healthier futures for our members.