Remote Senior Pharmacy PA/Appeals Specialist

UnitedHealth Group; Portland (ME); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Paid time off

Medical plan

Dental, Vision, Life & AD&D insurance

401(k) Savings Plan

Education reimbursement

Job summary

UnitedHealth Group's Optum unit is seeking a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals, processing requests via phone, fax, and electronic systems. The role requires attention to detail, regulatory compliance, and the ability to work remote if residing in Maine or Vermont, with a Monday–Friday schedule 8am–8pm EST and rotating on-call weekends.

Responsibilities include handling high volumes of inquiries, verifying information, and escalating pharmacist

Qualifications

• Active and unrestricted Pharmacy Technician licensure/registration in home state.
• 6+ months of experience in healthcare or customer service.
• Certification as PTCB or ExCPT required.

Responsibilities

• Manage a high volume of inbound and outbound calls, averaging 50+ daily, while maintaining professionalism, accuracy, and customer service expectations.
• Respond to prior authorization inquiries and requests from providers, pharmacies, members, and internal partners using approved scripts, reference materials, job aids, policies, and procedures.
• Review and process prior authorization requests through multiple computer systems, ensuring required information is complete, accurate, and documented in accordance with compliance, regulatory, client, and business requirements.
• Research formulary, benefit, medication, eligibility, and plan‑specific information to help resolve prior authorization questions, benefit issues, and case‑processing barriers.
• Gather and verify member, provider, prescriber, pharmacy, medication, diagnosis, and clinical support information needed for pharmacist consultation or clinical review.
• Identify missing or incomplete information and take appropriate follow‑up action, including outbound calls or routing to the appropriate team, pharmacist, or clinician when needed.
• Prioritize work to support required turnaround times for standard, expedited, urgent, and client‑specific prior authorization requests.
• Maintain productivity, quality, schedule adherence, attendance, and documentation standards in a fast‑paced, metric‑driven environment.
• Resolve issues and complaints in a timely, professional manner and elevate concerns when additional support, clinical review, or leadership guidance is required.

Skills

Customer service

Attention to detail

Communication

Education

Pharmacy Technician Certification (PTCB)

ExCPT

State Pharmacy Licensure/Registration

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Microsoft Teams

Job description

UnitedHealth Group's Optum unit is seeking a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals, processing requests via phone, fax, and electronic systems. The role requires attention to detail, regulatory compliance, and the ability to work remote if residing in Maine or Vermont, with a Monday–Friday schedule 8am–8pm EST and rotating on-call weekends.

Responsibilities include handling high volumes of inquiries, verifying information, and escalating pharmacist