PBM Call Center Manager - Remote US
About The Position
Gainwell Technologies is seeking an experienced PBM Call Center Manager to lead day-to-day operations within a Pharmacy Benefit Management (PBM) call center environment. In this role, you will oversee service delivery while driving operational performance, quality, compliance, and an exceptional customer experience. The ideal candidate brings strong healthcare operations and contact center leadership experience, with knowledge of Medicaid and/or PBM operations. You will lead teams, monitor performance and service levels, manage escalations, and partner across the organization to continuously improve processes and outcomes. You will work remotely from home while leading and supporting a geographically dispersed healthcare operations team. Work in a fast-paced, performance-driven environment focused on quality, compliance, operational excellence, and customer service. Regularly collaborate with clients, internal business partners, pharmacies, providers, and other healthcare stakeholders. Use operational data and performance metrics to identify trends, address service gaps, and drive continuous improvement.
Requirements
- Three (3) or more years of experience in healthcare, Medicaid, PBM, pharmacy, or related healthcare operations.
- Demonstrated leadership experience managing teams within a high-volume call center or contact center environment; five (5) or more years of call center leadership experience is preferred.
- Strong knowledge of call center operations, including SLAs, KPIs, quality management, workforce planning, performance management, and customer experience.
- Knowledge of NCPDP standards and healthcare regulatory and compliance requirements.
- Strong analytical, communication, problem-solving, and leadership skills with the ability to analyze data and translate findings into operational improvements.
Nice To Haves
- Medicaid/PBM experience strongly preferred; experience with pharmacy claims, prior authorization, Lean Six Sigma, project management, and/or Pharmacy Technician certification is a plus.
Responsibilities
- Lead day-to-day PBM call center operations, ensuring service levels, productivity, quality, and customer experience goals are achieved.
- Lead, coach, and develop supervisors and customer service teams through effective performance management, ongoing feedback, and employee development.
- Monitor and analyze SLAs, KPIs, quality metrics, customer satisfaction, and operational trends to identify opportunities for improvement.
- Ensure compliance with Medicaid, HIPAA, PBM, contractual, and applicable regulatory requirements.
- Oversee workforce planning, staffing, scheduling, training, and operational readiness to effectively support business and client needs.
- Partner with clients, pharmacies, providers, state stakeholders, and internal teams to resolve escalations, address service issues, and implement process improvements.
Benefits
- Comprehensive benefits for eligible employees, including medical, dental, and vision coverage, access to a 401(k) retirement savings plan, and additional employee wellness and financial benefits.
- Opportunities for professional development and career growth within Gainwell Technologies.
- generous, flexible vacation policy
- a 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
