California Pharmacy Resolution Specialist

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

Key Responsibilities

Receive and respond to calls from members, providers, and pharmacies regarding benefit questions and prior authorization requests

Log, track, and resolve inquiries and complaints while adhering to regulatory and corporate guidelines

Maintain expert knowledge of pharmacy benefits and formularies, and assist with special projects as assigned

Required Qualifications

High School Diploma or GED

One year of job-specific call center or customer service experience

Knowledge of pharmacy and medical benefits

Ability to interpret CMS regulations related to pharmacy benefits

Experience in handling prior authorization and coverage determination processes