Member Services Specialist – Medication Access & Support Programs at Maven

, , -

Full Time

Start Date

Immediate

Expiry Date

23 Mar, 26

Salary

0.0

Posted On

23 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer Support, Insurance Navigation, Pharmacy Coordination, Problem Solving, Empathy, Communication, Detail Orientation, Organizational Skills, Multi-tasking, Google Workspace, Zendesk, Medication Access, Chronic Condition Support, Prior Authorization, Spanish Fluency

Industry

Hospitals and Health Care

Description

Maven is the world's largest virtual clinic for women and families on a mission to make healthcare work for all of us. Maven's award-winning digital programs provide clinical, emotional, and financial support all in one platform, spanning fertility & family building, maternity & newborn care, parenting & pediatrics, and menopause & midlife. More than 2,000 employers and health plans trust Maven's end-to-end platform to improve clinical outcomes, reduce healthcare costs, and provide equity in benefits programs. Recognized for innovation and industry leadership, Maven has been named to the Time 100 Most Influential Companies, CNBC Disruptor 50, Fast Company Most Innovative Companies, and FORTUNE Best Places to Work. Founded in 2014 by CEO Kate Ryder, Maven has raised more than $425 million in funding from top healthcare and technology investors including General Catalyst, Sequoia, Dragoneer Investment Group, Oak HC/FT, StepStone Group, Icon Ventures, and Lux Capital. To learn more about Maven, visit us at mavenclinic.com. An award-winning culture working towards an important mission – Maven Clinic is a recipient of over 30 workplace and innovation awards, including: Fortune Change the World (2024) CNBC Disruptor 50 List (2022, 2023, 2024) Fortune Best Workplaces for Millennials (2024) Fortune Best Workplaces in Health Care (2024) TIME 100 Most Influential Companies (2023) Fast Company Most Innovative Companies (2020, 2023) Built In Best Places to Work (2023) Fortune Best Workplaces NY (2020, 2021, 2022, 2023, 2024) Great Place to Work certified (2020, 2021, 2022, 2023, 2024) Fast Company Best Workplaces for Innovators (2022) Built In LGBTQIA+ Advocacy Award (2022) Maven is seeking a Member Services Specialist to support members in a new, fast growing care program involving complex GLP-1 medication access, pharmacy coordination, and sensitive chronic condition support. This role blends high volume omni channel support with deeper insurance and pharmacy navigation to ensure members receive clear guidance, timely medication access, and a compassionate experience throughout their treatment journey. You will help members understand benefit requirements, coordinate with partner pharmacies, resolve fulfillment issues, and navigate sensitive health conversations with care. You’ll also work closely with clinical operations, pharmacy partners, and internal teams to reduce friction and improve the GLP-1 medication access process. This role is ideal for someone who enjoys problem solving across multiple systems, thrives in a fast paced queue-oriented environment, and has experience supporting programs involving high demand, tightly regulated, or insurance intensive medications. Our Member Services team works remotely and supports Maven members 7 days/week. We are currently hiring for the following shifts: Mon–Fri 8:30 AM – 5:00 PM Mon–Fri 1:00 PM – 9:30 PM Sun–Thurs 8:30 AM – 5:00 PM (Sun: 9:00 AM – 5:30 PM) Tues–Sat 8:30 AM – 5:00 PM (Sat: 9:00 AM – 5:30 PM) What You’ll Do Member & Pharmacy Support 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. Insurance, Coverage & Benefits Navigation 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. Medication Access & Issue Resolution 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. Member Experience & Sensitive Communication 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. Documentation, Quality & Continuous Improvement 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. Compliance & Risk Management 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. Qualifications 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 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. At Maven we believe that a diverse set of backgrounds and experiences enrich our teams and allow us to achieve above and beyond our goals. If you do not have experience in all of the areas detailed above, we hope that you will share your unique background with us in your application and how it can be additive to our teams. Benefits That Work For You Our benefits are designed to support your health, well-being and career development, helping you thrive both personally and professionally. We remain focused on providing a competitive benefits package for our employees. On top of standards such as employer-covered health, dental, and insurance plan options, we offer an inclusive approach to 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 These benefits are applicable to Maven Clinic Co., US-based, full-time employees only. 1099/Contract Providers are ineligible for these benefits. Maven is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Maven is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Maven Clinic interview requests and job offers only originate from an @mavenclinic.com email address (e.g jsmith@mavenclinic.com). Maven Clinic will never ask for sensitive information to be delivered over email or phone. If you receive a scam issue or a security issue involving Maven Clinic please notify us at: security@mavenclinic.com. For general and additional inquiries, please contact us at careers@mavenclinic.com.

How To Apply:

Incase you would like to apply to this job directly from the source, please click here

Responsibilities

The Member Services Specialist will assist members with medication access, coordinate with pharmacies, and resolve fulfillment issues. They will also provide empathetic support and navigate sensitive health conversations.