Senior CPhT - PBM Pharmacy Support Specialist (Remote)

Gainwell Technologies LLC; Columbus (OH); Remote; USD 42,000 - 60,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Generous vacation policy

Educational assistance

Leadership and technical development

Job summary

Gainwell Technologies LLC is seeking a Senior Certified Pharmacy Technician for its PBM Clinical and Technical Call Center. This role focuses on delivering expert support to members, providers, and pharmacy partners across multiple channels, resolving complex benefit questions and ensuring timely service.

The position emphasizes advanced pharmacy knowledge, PBM experience, and the ability to coordinate prior authorization processes, train teammates, and contribute to process improvements while

Qualifications

• Active and current CPhT credential.
• Minimum of 2 years of call center experience in healthcare or PBM.
• Minimum of 2 years of PBM experience including formulary management, pharmacy claims adjudication, and benefit interpretation.
• Strong knowledge of pharmacy claims processing and claim rejection resolution.
• Strong verbal and written communication skills, computer proficiency, attention to detail, and ability to work across multiple systems in a fast-paced environment.
• Previous leadership experience, retail pharmacy or PBM call center experience, familiarity with pharmacy management systems, and bilingual skills are preferred.

Responsibilities

• Provide advanced support to members, prescribers, and pharmacy providers through phone, fax, email, and web-based channels.
• Research and resolve complex pharmacy benefit inquiries, including claims, rejections, formulary questions, and medication access issues.
• Support and coordinate prior authorization processes and ensure requests are handled within guidelines.
• Serve as a subject matter expert for team members, assisting with escalated issues and training.
• Contribute to quality and process improvement initiatives while meeting service, productivity, compliance, and customer experience standards.

Skills

CPhT credential

Call center experience

PBM experience

Formulary management

Pharmacy claims processing

Prior authorization

Strong communication

Multi-system navigation

Tools

Pharmacy management systems

Job description

Gainwell Technologies LLC is seeking a Senior Certified Pharmacy Technician for its PBM Clinical and Technical Call Center. This role focuses on delivering expert support to members, providers, and pharmacy partners across multiple channels, resolving complex benefit questions and ensuring timely service.

The position emphasizes advanced pharmacy knowledge, PBM experience, and the ability to coordinate prior authorization processes, train teammates, and contribute to process improvements while