Massachusetts Pharmacy Operations Representative

Job Summary

Serving as the primary contact for providers, the full-time Massachusetts Pharmacy Operations Representative will manage authorization requests for retail pharmacy, home infusion, and medical utilization management, while supporting inquiries from various business areas via phone and email.

Key Responsibilities

• Receive, process, and archive provider authorization requests accurately using multiple computer systems
• Review member eligibility and claims history to provide information to internal and external clients
• Communicate determinations to providers through incoming and outgoing telephone calls

Required Qualifications

• Minimum of a High School diploma required; Associate or Bachelor's degree preferred
• Proficiency in MHK and PBM System preferred
• Previous experience in a managed care environment preferred
• Strong organizational skills and ability to multitask
• Prior experience assisting members and/or providers with telephone inquiries