Pharmacy Resolution Specialist

Job Summary

A company is looking for a Pharmacy Resolution Specialist who will handle inquiries and resolve issues related to pharmacy benefits.

Key Responsibilities

• Responds to calls from members, providers, and pharmacies regarding benefit questions and prior authorization requests
• Researches and resolves issues while logging and tracking all inquiries to meet performance standards
• Maintains knowledge of pharmacy benefits and regulations, and assists with special projects as assigned

Required Qualifications

• High School Diploma or GED
• Minimum of 1 year of experience in a call center or customer service role
• Knowledge of pharmacy and medical benefits
• Ability to interpret CMS regulations related to pharmacy benefits
• Experience with prior authorization processes and claims resolution