Pharmacy Benefit Operations Supervisor
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Job Description
Pharmacy Solutions Operations Supervisor at Point C managing pharmacy member support operations. Ensuring quality service and training for new employees in a remote role.
Responsibilities:
- Oversees and manages pharmacy phone queue, ensuring exceptional member experience, appropriate documentation, and effective customer service.
- Tracks key performance indicators and provides reports to manager in a timely manner.
- Maintains reasonable member satisfaction goals and works with the team to meet them.
- Interacts with members should calls need to be escalated to management.
- Onboards new employees and trains them based on their expertise and skill set.
- Proactively identifies potential member disruption.
- Answer inbound calls and return voicemails from members, delivering exemplary customer service and support.
- Troubleshoot and resolve prescription-related issues for members whose plans utilize CVS or Carelon as the PBM.
- Coordinate with providers’ offices and retail/mail-order pharmacies as needed to resolve claims processing, prior authorization, and medication access issues.
- Document all actions, progress, and communication in the ticketing system and Acuity, updating ticket status in accordance with internal standards.
- Conduct proactive member outreach, including but not limited to disruption list communications and follow-up calls.
- Collaborate closely with Pharmacy Services team members and cross-functional departments to ensure timely resolution of pharmacy-related concerns.
- Perform other duties as assigned.
Requirements:
- Active or eligible Pharmacy Technician license/certification (state-specific requirements apply). National Certification is preferred.
- 1–2+ years of experience in a pharmacy on the health plan/carrier side.
- Strong understanding of pharmacy operations, prescription workflows, and medication terminology.
- Experience troubleshooting pharmacy or claims issues with PBMs such as CVS, Carelon, Optum, or Express Scripts (preferred).
- Excellent verbal and written communication skills, with the ability to deliver clear and compassionate support.
- Proficient in navigating systems such as ticketing platforms, pharmacy software, or claims tools (experience with Acuity is a plus).
- High attention to detail, strong organizational skills, and ability to manage multiple priorities in a fast-paced environment.
- Commitment to confidentiality, accuracy, and a positive member experience.
Benefits:
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
- Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
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