Customer Care Representative

TL;DR

Customer Care Representative (PBM/Healthcare): Triage incoming phone calls from members and pharmacies, document and escalate concerns, and drive first-call resolution with HIPAA-compliant support. Focus on de-escalating customer issues in a fast-paced, metric-driven remote call center while supporting Fraud, Waste, and Abuse review and meeting quality and attendance goals.

Location: Remote (US)

Salary: $26.00/hour (USD)

Company

hirify.global provides enterprise health technology solutions for employers and health plans, including PBM and health benefit management platforms.

What you will do

• Triage incoming phone calls with professional etiquette, ask probing questions, and resolve member and pharmacy issues with minimal support.
• Support call center staff and collaborate with internal Operations teams to identify, document, and escalate concerns.
• Communicate clearly with members, pharmacies, and internal stakeholders to ensure resolutions meet health and safety standards.
• De-escalate customer concerns and deliver first-call resolution with compassion in a fast-paced environment.
• Follow Standard Operating Procedures and adhere to HIPAA guidelines and company policies.
• Review pharmacy claims information to support the Fraud, Waste, and Abuse program and report findings to the appropriate internal staff.

Requirements

• High school diploma or equivalent; Associate’s or Bachelor’s degree preferred.
• 2+ years of customer service and call center and/or healthcare experience.
• 2+ years of PBM or related healthcare experience.
• Ability to work independently with minimal supervision in a remote, high-volume, fast-paced, metric-driven call center environment.
• Must be able to work standard training hours: Monday–Friday, 9:00am–5:30pm Eastern.
• HIPAA compliance and adherence to company policies.

Nice to have

• Bilingual Spanish.
• Medicare experience.

Culture & Benefits

• Remote work with a fast-paced, metric-driven call center environment.
• Training hours scheduled Monday–Friday during Eastern time.
• Quality monitoring, schedule adherence, and attendance goals.
• Emphasis on compassion, customer satisfaction, and de-escalation.
• Compliance-focused role with HIPAA and internal SOP adherence.

Hiring process

• Interviews and evaluation of customer service/call center experience and healthcare/PBM knowledge.
• Assessment of ability to work remotely in a high-volume, metric-driven environment.
• Final steps include confirming schedule availability for training hours.