Lead Specialist – Program Support

Cencora•Orange, CA

About The Position

This role involves advanced operations ownership, serving as the primary escalation point for provider/PBM/MCO issues, and overseeing day-to-day workload orchestration. The Lead Specialist will also act as a trainer and mentor for representatives, maintain and improve SOPs, and provide reporting and insights to management to support continuous improvement and leadership objectives.

Requirements

Able to understand market trends that effect pharmacy business.
Ability to work independently with minimal supervision; self starter.
Strong analytical skills and attention to detail.
Ability to convey results of analysis and resolve problems in a logical organized fashion.
Ability to manage multiple projects and deadlines.
Ability to communicate effectively, both orally and in writing, and strong interpersonal skills.
Possess decision making and problem solving ability.
Proficient in Microsoft Office Excel, Access, Word and Power Point.
Must be proficient in personal computers and server usage.
Possess a high discipline for performing quality work and a strong focus on customer satisfaction.

Nice To Haves

Experience with relational databases and knowledge of query tools and/or statistical business intelligence software (Micro Strategy) is beneficial.

Responsibilities

Leads complex workstreams including contract intake/review tracking, termination processing coordination, contract research, and maintenance of critical databases and files.
Oversees quality and timeliness of network communications and materials; ensures accuracy and alignment with current program rules.
Performs advanced invoice audit support per contract; supports A/R and A/P exception resolution where applicable.
Leads and manages the end-to-end credentialing process to ensure data accuracy and rapid turnaround — including collecting and updating licensing and insurance, FWA attestation, producing and delivering monthly full credentialing files to PBMs.
Serves as the primary escalation point for provider/PBM/MCO issues that impact participation, claims processing outcomes, or network roster accuracy.
Coordinates across internal teams (managed care directors, account management, retail sales leadership, compliance, operations) to drive decisions and resolution.
Establishes clear escalation pathways and ensures documentation of decisions, approvals, and outcomes.
Oversees day-to-day workload orchestration: call/email/fax case routing, priority assignment, aging management, and follow-through.
Tracks recurring issues, identifies root causes, and partners with management to implement corrective actions (process fixes, training, system requests).
Acts as primary trainer/mentor for reps; provides structured coaching on contracts, database governance, PBM interactions, and customer communication standards.
Maintains and improves SOPs, templates, and checklists; drives consistent adoption across the team.
Performs audits and spot checks to ensure data integrity in network databases and contract files.
Develops and provides reporting/trend insights (contact drivers, defects, rework rates, cycle time, escalation themes) to management; recommends process enhancements.
Supports leadership objectives related to customer experience, retention, and process efficiency by implementing best practices for membership/network accuracy, reducing avoidable escalations and rework, and improving turnaround times for provider-impacting requests.
Assists with drafting internal/external communications (as delegated) and ensuring message accuracy and compliance.