Customer Services Representative - Pharmacy MTM Services - Remote Eligible

Customer Service Representative

UPMC Health Plan is seeking a full-time Customer Service Representative to join our Medication Therapy Management team. This is a remote, Monday–Friday daylight role with flexible 8-hour shifts between 9:00 a.m. and 7:00 p.m. The initial shift is 11:00 a.m. – 7:00 p.m., with the option to move to 9:00 a.m. – 5:00 p.m. as the team grows. Occasional Saturday shifts are required (typically once every other month, based on business needs). In this role, you'll support pharmaceutical care by engaging with members, pharmacies, and providers to resolve medication-related issues. You'll work in alignment with state and federal regulations, NCQA standards, and UPMC Health Plan policies.

Why Join Us?

• Comprehensive benefits package
• Remote work privileges (based on performance and department needs)
• Extensive pharmacy training provided
• Opportunities for growth and advancement

Key Responsibilities:

• Handle inbound and outbound calls with efficiency and quality
• Stay current on departmental policies, formularies, and regulations
• Escalate appropriate cases to pharmacists
• Support pharmacists with medication review preparation
• Maintain accurate patient records and pharmacy systems
• Ensure privacy and confidentiality in compliance with HIPAA
• Resolve member concerns with first-call resolution
• Execute medication therapy management protocols
• Participate in quality improvement initiatives
• Assist in training new pharmacy personnel and students
• Document all interventions appropriately

Qualifications:

• Completion of High School Diploma or equivalent.
• Minimum 1 year customer service and/or call center experience.
• Excellent organizational, interpersonal, and communication skills
• Licensure, Certifications, and Clearances: Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran