Remote Senior Pharmacy PA & Appeals Specialist

UnitedHealth Group; Sugar Land (TX); Remote; USD 25,000 - 44,000; Full time

Job summary

UnitedHealth Group's Optum unit seeks a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals, handling inquiries from members, providers, and pharmacies. This role emphasizes accuracy, regulatory compliance, and timely processing across multiple channels, with telecommuting options for licensed technicians in listed states.

You will collaborate with pharmacists and clinicians, document actions clearly, and help improve health outcomes in a fast-paced, metric-driven

Qualifications

• Active and unrestricted Pharmacy Technician licensure or certification as required by state and business needs.
• Minimum 6 months of experience in customer service, healthcare, pharmacy, call center, or direct interaction with healthcare professionals.
• Basic proficiency with Microsoft Excel, Word, Outlook, and Teams.
• Ability to navigate multiple systems, screens, job aids, and electronic workflows while maintaining accuracy during calls and case processing.
• Ability to work any shift within 5:00 AM to 12:00 AM, including weekends and holidays.
• Located in one of the telecommute states listed in the ad.

Responsibilities

• Manage a high volume of inbound and outbound calls, averaging 50+ daily, with professionalism and accuracy.
• Respond to prior authorization inquiries from providers, pharmacies, members, and internal partners.
• Review and process prior authorization requests across multiple computer systems with complete, accurate documentation.
• Research formulary, benefits, medication, eligibility, and plan-specific information to resolve PA questions and barriers.
• Gather and verify member, provider, prescriber, pharmacy, medication, diagnosis, and clinical support information.
• Identify missing information and take appropriate follow-up actions or route to the relevant team.
• Prioritize work to meet turnaround times for standard, expedited, urgent, and client-specific PA requests.
• Maintain productivity, quality, schedule adherence, and documentation in a fast-paced environment.
• Resolve issues and escalate when additional support or leadership is needed.

Skills

Pharmacy Technician licensure

Customer service

MS Office basics

Multi-system navigation

Shift flexibility

Telecommuting

Education

PTCB Certification

State licensure (applicable state)

Tools

Excel

Job description

UnitedHealth Group's Optum unit seeks a Senior Pharmacy PA/Appeals Technician to support prior authorization and appeals, handling inquiries from members, providers, and pharmacies. This role emphasizes accuracy, regulatory compliance, and timely processing across multiple channels, with telecommuting options for licensed technicians in listed states.

You will collaborate with pharmacists and clinicians, document actions clearly, and help improve health outcomes in a fast-paced, metric-driven