Think Beyond The Label Jobs

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

Put your passion where it meets purpose! Evolent attracts some of the brightest minds in health care. Surround yourself with talented, driven colleagues who share a passion for better health outcomes and a more connected care journey. We are hiring for a Team Lead to join our Pharmacy Care Customer Service Team.

The Team Lead, Customer Service position is a key member of our Customer Service Organization (CSO) team. This individual will be responsible for assisting staff in a matrix environment to ensure the team delivers the highest possible quality service to our all benefits managed by the CSO for our Health Plan partners, including members, providers, and other constituents. This position will assist with leading the team in achieving and maintaining service levels and customer experience, understanding that service has a direct impact on plan performance.

Collaboration Opportunities:

• Team Leads work directly with our Supervisors and Customer Service Representatives (CSR’s) to assist with providing support to health plan members, providers and/or their representatives, as it relates to our Pharmacy and Medical benefits. Collaboration can enhance overall team performance, improve customer satisfaction, and contribute to the success of the organization.

What You Will Be Doing:

• The Team Lead provides support to Customer Service inbound pharmacy team members ensuring the team handles all customer inquiries in a timely, professional and courteous manner, including phone calls or correspondence regarding benefits, eligibility, and all other inquiries and requests as well as assist Supervisors to handle complaints/grievances

• In addition will need to support calls to pharmacy and/or provider contacts for pharmacy benefit information, clinical determinations, and program information

• Assists in leading customer service agents in all day-to-day activities to consistently meet established customer service/contact center service levels/metrics

• Staff the agent Team “help desk” and quickly respond to agent questions and guidance throughout the assigned shift; handle real-time escalations where appropriate

• Coordinate and triage all pharmacy inquiries (i.e. phone, fax, correspondence, electronic media) and resolve all customer issues; ensuring accurate information is provided

• Function as liaison and subject matter expert related to client PBM systems and processes. Specifically related to drug utilization management, drug prior authorization and pharmacy claim adjudication

• Help to obtain verbal prior authorization requests from member and/or prescribers while compiling and documenting accurate conversation details.

• Assists with the Prior Authorization process

• Always maintain the confidentiality of protected patient medical information

• Take pharmacy customer calls as scheduled. Responds to inquiries via telephone and other communication channels, regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics. Conducts out-bound and/or return calls to customers, as necessary

• Assist Supervisors in handling escalated pharmacy service issues as needed.

• Assists CSO supervisor in mentoring and giving feedback to customer service agents while handling agent help requests

• Assists in creating a positive work environment that ensures the staff works well as a team, are highly motivated and feel valued

• Monitors departmental performance standards and reports; reviews department performance reports and actively collaborates with management and staff to ensure that "best practices" are followed

• Adheres to all applicable department, organization and/or regulatory policies and procedures

• Attend training to maintain currency on programs; support adoption of new procedures/policies

• Responsible for staying current and maintaining a working knowledge/ understanding of the health plan related guidelines, processes and protocols

• Participates in designated cross department work group and attend required meetings, as needed

• Notify physicians, providers, and members of coverage determination request decisions

• Ability to adapt to a changing environment including scheduling flexibility with the ability to work evening and weekend hours, as necessary

• Perform other duties and projects as assigned

Qualifications - Required and Preferred:

• 1 - 2+ years working experience at Evolent health plan, PBM, clinical pharmacy or operations team with Call Center experience is required

• 1+ years working with pharmacy related operations preferred

• Certified Pharmacy Technician (CPhT) is preferred

• High school diploma or equivalent is required

• Associate's degree in healthcare, business, or healthcare related field is a plus

• Bi-lingual in Spanish and English is a plus

• 2-3 years’ experience with customer service/call center operations within a managed care organization, health plan, PBB (Pharmacy Benefit Manager) or third-party administrator is preferred

• 2-4 years of supervisory or equivalent experience supporting customer service, call center or related departments is preferred

• Outstanding communication skills and the ability to understand complex situations to effectively handle escalated customer needs

• Ability to work independently and as part of a team

• Ability to work and lead team members remotely and support Evolent customers in varying time zones (M-F between 8 AM to 9 PM (EST)

• Ability to learn and use computer software system and ACD phone system to perform job functions

• Ability to maintain pleasant demeanor when dealing with difficult calls and multi-task to complete calls and serve customers in a timely manner

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.

The expected base salary/wage range for this position is $23.00 per hour. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

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