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Pharmacy Resolution Specialist
This job is now closed
Job Description
- Req#: 1624177
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $27.25 per hour
- Comprehensive benefits package including health insurance, 401K, stock purchase plans, and tuition reimbursement
- Flexible work options with opportunities for remote, hybrid, field, or office schedules
- Paid time off plus holidays
- Opportunity to make a positive impact on member experiences
What to Expect (Job Responsibilities):
- Receive and respond to calls from members, providers, and pharmacies regarding benefit inquiries and prior authorization requests
- Research issues thoroughly and take appropriate actions to resolve them according to established guidelines
- Log, track, and resolve all assigned inquiries and complaints while adhering to regulatory and corporate standards
- Maintain expert knowledge of pharmacy benefits and formularies, along with relevant CMS regulations
- Conduct inbound and outbound calls to provide resolutions for claims and assist with prior authorization and appeals
What is Required (Qualifications):
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship
- High School Diploma or GED
- Minimum of 1 year of job-specific call center/customer service experience
- Strong attention to detail and ability to meet performance standards
- Knowledge of pharmacy and medical benefits
How to Stand Out (Preferred Qualifications):
- Experience in a healthcare-related call center environment
- Familiarity with CMS regulations and pharmacy benefits
- Strong problem-solving skills and ability to identify root cause issues
#HealthcareServices #CustomerService #CareerOpportunity #CompetitivePay #RemoteWork
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