Pharmacy Resolution Specialist

A company is looking for a Pharmacy Resolution Specialist.

Key Responsibilities

Receive and respond to calls from members, providers, and pharmacies regarding benefit questions and prior authorization requests

Research issues and take appropriate actions to resolve inquiries while adhering to regulatory and corporate guidelines

Log, track, and resolve assigned inquiries and complaints, ensuring compliance with performance standards

Required Qualifications

High School Diploma or GED

One year of job-specific call center or customer service experience

Expert knowledge of pharmacy benefits and formularies

Ability to interpret pharmacy and medical benefits

Experience in handling prior authorization and appeals processes