Senior Pharmacy Resolution Specialist

Centene; United States; Remote; USD 80,000 - 100,000; Full time

Job summary

Join a dynamic and diverse organization that is dedicated to making a difference in the lives of millions. As a Senior Pharmacy Resolution Specialist, you will leverage your expertise to navigate complex pharmacy inquiries and provide exceptional service to members and healthcare providers. This role offers the opportunity to work in a collaborative environment, where your contributions will directly impact patient care and operational efficiency. Enjoy a flexible work schedule and a comprehensive benefits package that supports your professional growth and personal well-being. If you are passionate about healthcare and customer service, this is the perfect opportunity for you.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• 2 years of experience in a call center or customer service role.
• Experience in healthcare environments such as pharmacy operations.

Responsibilities

• Handle complex pharmacy issues and escalated calls from members and providers.
• Research and resolve inquiries while maintaining quality standards.
• Assist in training less experienced staff and participate in audits.

Skills

Customer Service

Pharmacy Operations Knowledge

Problem Solving

Communication Skills

Education

High School Diploma / GED

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Qualified candidates must be able to work 2PM-10:30PM EST Monday-Friday.

Position Purpose: The Senior Pharmacy Resolution Specialist will act as a subject matter expert and handle more complex pharmacy issues and respond to escalated calls from members, provider/physician's offices, and pharmacies. This role will make outbound calls and enter pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists.

1. Takes member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests.
2. Offers options including submission of a prior authorization request.
3. Thoroughly researches issues and takes appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards.
4. Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims (i.e.: additional information requests and medication determination updates).
5. Assists team members often guiding them to the appropriate resolution of more complex and difficult inquiries.
6. Participates in the training of less experienced staff, including opportunity for job shadowing.
7. Acts as a liaison between internal departments on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility.
8. Presents proposed solutions in a clear and concise manner.
9. Assists with audit preparation as needed.
10. Assists with miscellaneous special project work as assigned.
11. Performs other duties as assigned.
12. Complies with all policies and standards.

Education/Experience: High School Diploma / GED. 2 years of experience. Call center / customer service experience. Experience in healthcare environment (pharmacy operations, managed care, pharmacy hospitals, and/or pharmacy retail settings).

License/Certification: Pharmacy technician certification preferred. Pay Range: $19.04 - $32.35 per hour.

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.