Senior Pharmacy Authorization Specialist (Remote)

Highmark; United States; Remote; USD 27,000 - 38,000; Full time

Job summary

Highmark Inc. is seeking a Pharmacy Call Center Reviewer to provide frontline guidance and ensure compliant, efficient delivery of Pharmacy call center services on a national level.

The role includes responding to physician and pharmacy network inquiries, reviewing prior authorizations, and coordinating with clinical staff on denied claims and formulary questions. The position supports remote work with standard hours and requires collaboration with providers to uphold health plan policies and

Qualifications

• High school diploma or GED required.
• Experience in pharmacy prescription claims processing/submission/payment preferred.

Responsibilities

• Communicate effectively with physician and pharmacy network providers to ensure provider and plan member needs are addressed.
• Interact with staff to implement processes and problem solve.
• Respond to drug benefit design inquiries or exception requests and evaluate daily workflow.

Skills

pharmacy claims processing

communication skills

multi-tasking

Education

High school diploma or GED

Associate degree

Pharmacy technician certification

Tools

Outlook

Word

OnBase

Job description

Highmark Inc. is seeking a Pharmacy Call Center Reviewer to provide frontline guidance and ensure compliant, efficient delivery of Pharmacy call center services on a national level.

The role includes responding to physician and pharmacy network inquiries, reviewing prior authorizations, and coordinating with clinical staff on denied claims and formulary questions. The position supports remote work with standard hours and requires collaboration with providers to uphold health plan policies and