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

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

Senior Pharmacy Resolution Specialist

Key skills