PSS - Care Coordination Specialist

Position Summary

The PSS Care Coordination Specialist is the front-line ambassador for our pharmacy team. This role focuses heavily on delivering a high level of service by handling high-volume inbound communications from members and healthcare providers. This role will be responsible for triaging incoming inquiries, managing administrative tasks, and ensuring all front-line interactions are resolved, logged, and routed accurately.

• Front-Line Customer Service: Answer and manage inbound calls from members and providers, consistently delivering a high level of professional service.
• Call Triage & Routing: Efficiently triage complex clinical or technical inquiries, routing them to the appropriate clinical or advanced operations teams.
• Concern Resolution: Resolve and meticulously log standard member or provider concerns in the internal tracking system.
• Administrative Support: Complete foundational administrative tasks related to incoming prior authorizations and appeals (e.g., document sorting, data entry, case routing).
• Outbound Outreach: Support the clinical pharmacy team by making routine outbound informational calls to members and providers.
• Operational Flexibility: Perform additional basic operational projects and tasks as needed by the management team.
• Other duties as required.*

*This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

• Education: High school diploma or equivalent
• Experience: Proven experience working in a call center or high-volume phone customer service environment is required.
• Communication: Excellent verbal and written communication skills are a must.
• Healthcare Knowledge: Experience in Pharmacy Benefit Management (PBM) operations or the general healthcare industry is preferred but not required.
• Technical Comfort & CRM Navigation: Highly comfortable adapting to new digital tools and navigating multi-screen workflows, including Customer Relationship Management (CRM) modules, ticketing platforms, and basic database software to accurately log and route customer interactions.
• Technical Skills: Proficiency in Google Work products (Docs, Drive, Slides) and Microsoft Office (Word, PowerPoint, Excel).
• Mindset: Fast learner with a strong interest in potential growth opportunities as product roles expand.

Company Standard Requirements:

• Ability to work well with others in a collaborative environment
• Ability to get things done with resources you don’t control
• Willingness to admit you don’t know and ask for help
• Exhibit constant curiosity and a drive to problem solve
• Exhibit desire to learn and grow on a continuous basis