Senior Pharmacy Resolution Specialist
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Job Description
Senior Pharmacy Resolution Specialist acting as a subject matter expert on pharmacy issues. Handling escalated calls and providing resolutions for healthcare providers and members.
Responsibilities:
- Act as a subject matter expert on complex pharmacy issues
- Respond to escalated calls from members, provider/physician's offices, and pharmacies
- Make outbound calls and enter pharmacy overrides into systems
- Take member/prescriber/pharmacist inquiry calls for benefit questions
- Offer options including submission of prior authorization requests
- Research issues and take appropriate action to resolve them
- Conduct inbound and outbound calls for claims resolution
- Assist team members in guiding them to appropriate resolution of inquiries
- Participate in training less experienced staff
- Act as a liaison between internal departments for data gathering and problem solving
- Present proposed solutions clearly
- Assist with audit preparation and special project work as assigned
- Comply with all policies and standards
Requirements:
- High School Diploma / GED
- 2 years of experience
- Call center / customer service experience
- Experience in healthcare environment (pharmacy operations, managed care, pharmacy hospitals and or pharmacy retail settings)
- Pharmacy technician certification preferred
Benefits:
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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