Job Description

Job Title: Team Leader, Pharmacy Operations
Job ID: 692351
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: PHARMACY SRVCS
Location: 600 Grant St, Pittsburgh PA 15219

Description


Are you a health insurance professional with a strong pharmacy background?  If so, an opportunity as a Team Leader with the Pharmacy Operations team may be the perfect fit for you.  In this role, you will provide technical and plan support to a multi-functional pharmacy services team. You will assist with the team attainment of designated processing standards while ensuring excellent customer satisfaction for both internal and external customers. You will be responsible for effectively monitoring work queues and assigning function based on the needs of the department. As well as, assume supervisory responsibility as necessary and assist with the coaching, development and training of all team members.

 

This position could possibly work a rotating schedule with extended business hours. Additionally, this position will need to work overtime as business need dictates.


Responsibilities:
  • Allocate resources to ensure attainment of all call performance standards.
  • Assist in the development/refinement of policies and procedures.
  • Assist in the resolution of difficult claim inquiries; provide expert certificate of coverage interpretation and system support.
  • Assist with the attainment of phone call quality to meet or exceed the minimum standard established.
  • Assist with the counseling process as requested.
  • Continually examine team performance, provide feedback, make recommendations and implement action plans to meet designated standards.
  • Ensure an adequate supply of member and provider materials are on hand and available for mailing.
  • Interface with customers via telephone, correspondence and/or in person to answer inquires, resolve concerns and ensure customer satisfaction.
  • Maintain a positive work environment through employee recognition and interaction.
  • Maintain employee and insured confidentiality.
  • Maintain reports to assist in attainment of standards, identify root cause of potential or existing problems.
  • Meet with clients as necessary and conduct prospective client tours.
  • Monitor and manage queue volumes.
  • Monitor and refine workflow to facilitate communication and teamwork between departments.
  • Participate in interviewing, hiring and training of team members when requested.
  • Participate in team meetings and provide information to team members in a timely manner.
  • Support and develop cross-functional team members.
  • Support other departments as requested during periods of backlogs.

Qualifications

  • High school graduate. 
  • Two to five years experience in Insurance, Managed Care, Benefits Administration environment or Customer Service environment.
  • Excellent organizational, interpersonal and communication skills.  
  • Expert knowledge of medical terminology, ICD-9 and CPT-4 coding. 
  • Strong analytical ability.
  • Keyboard dexterity. 
  • MS Office/PC skills.
  • Previous pharmacy experience strongly preferred. 

Licensure, Certifications, and Clearances:
Within one year from date of hire or date of transfer into position, completion of UPMC HP Member Services Pathway to Leadership for Team Lead and receipt of certificate of completion is required

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $18.24 to $30.32

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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