Role Description
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Direct, coach, and develop team members through regular 1:1 meetings.
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Complete performance reviews, coaching documentation, and corrective actions.
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Manage staffing, schedules, queue performance, and workload balancing.
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Review KPIs including Quality, AHT, Productivity, Attendance, and SLA.
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Identify training opportunities and partner with Learning & Development.
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Handle escalated member, provider, and client concerns.
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Monitor daily operational performance against SLA, productivity, quality, and schedule adherence goals.
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Ensure compliance with HIPAA, CMS, state board of pharmacy requirements, and internal policies.
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Use reporting to identify trends and recommend corrective actions.
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Partner with Workforce Management, Training, Operations, and Leadership.
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Support continuous improvement initiatives and standardization efforts.
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Maintain documentation and confidentiality standards.
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Participate in calibration sessions and business meetings.
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Lead or support special projects as assigned.
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Support non-clinical prescription processing and participant service workflows.
Qualifications
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Strong written and verbal communication.
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Leadership and relationship-building skills.
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Critical thinking and analytical ability.
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Ability to prioritize competing demands.
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Experience working across multiple pharmacy systems.
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Proficiency with Microsoft Office, particularly Excel.
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Ability to maintain confidentiality.
Requirements
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High School Diploma or GED.
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Three or more years of relevant PBM, specialty pharmacy, participant services, or healthcare operations experience.
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Previous leadership or quality experience appropriate to the role.
Preferred Qualifications
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Active Arizona or Texas Pharmacy Technician License.
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National Pharmacy Technician Certification (CPhT).
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PBM or specialty pharmacy experience.
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Call center healthcare operations experience.
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Lean/Six Sigma or process improvement exposure.
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Experience presenting operational metrics.
Performance Measures
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Quality audit performance
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Productivity and throughput
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Service Level (SLA) attainment
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Attendance and schedule adherence
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Compliance and documentation accuracy
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Customer experience
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Coaching effectiveness and continuous improvement
Work Environment & Physical Requirements
Fast-paced, computer-based participant services environment requiring prolonged sitting, frequent computer use, telephone communication, and the ability to manage multiple priorities while maintaining accuracy and professionalism.