Senior CPhT - Remote PBM Expert

Gainwell Technologies LLC; Ohio; Remote; USD 42,000 - 60,000; Full time

Benefits offered by this job

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking a Senior Certified Pharmacy Technician for its PBM Clinical and Technical Call Center. You will act as a subject matter expert assisting members, providers, and pharmacy providers with complex benefit questions and access needs.

Role involves resolving complex inquiries, supporting escalations, and ensuring accurate, timely service across phone, fax, email, and web channels. Remote work options apply with emphasis on compliance and quality standards.

Qualifications

• Active and current Certified Pharmacy Technician (CPhT) credential.
• Minimum of 2 years of call center experience, preferably in healthcare or PBM.
• Minimum of 2 years of PBM experience, including formulary management and benefit interpretation.
• Strong knowledge of pharmacy claims processing and claim rejection resolution.
• Strong verbal and written communication skills and ability to work across multiple systems.

Responsibilities

• Provide advanced support to members, prescribers, and pharmacy providers across channels (phone, fax, email, web).
• Research and resolve complex PBM inquiries including claims, rejections, formulary questions, and access issues.
• Support prior authorization processes and ensure timely, guideline-based handling.
• Serve as SME, assist with escalations, and support training and onboarding.
• Contribute to quality and process improvement while meeting service, productivity, and compliance standards.

Skills

CPhT credential

Call center experience

PBM experience

Pharmacy claims knowledge

Communication skills

Job description

Gainwell Technologies is seeking a Senior Certified Pharmacy Technician for its PBM Clinical and Technical Call Center. You will act as a subject matter expert assisting members, providers, and pharmacy providers with complex benefit questions and access needs.

Role involves resolving complex inquiries, supporting escalations, and ensuring accurate, timely service across phone, fax, email, and web channels. Remote work options apply with emphasis on compliance and quality standards.