This is a fully remote, high-volume inbound call role supporting the criteria-based prior authorization process. The Pharmacy Technician provides professional, courteous assistance to members, providers, and healthcare professionals while reviewing clinical information and ensuring accurate documentation of determinations. This position is safety-sensitive and requires strong customer service skills, attention to detail, and the ability to work in a fast-paced environment.
Work Schedule
- 8-hour shifts with two 15-minute breaks and one 30-minute lunch
- Hours of operation : 8 : 00 AM – 11 : 00 PM CST (possible weekends)
- Final shift assignments determined after training based on business needs
Key Responsibilities
Manage a high volume of inbound calls from members, providers, and healthcare professionals.Provide exceptional customer service while guiding callers through the prior authorization process.Review clinical documentation to ensure completeness and eligibility according to established criteria.Accurately document all prior authorization approvals and denials in a timely manner.Escalate complex inquiries or cases requiring clinical judgment to a pharmacist for further evaluation.Maintain compliance with regulatory requirements, internal protocols, and confidentiality standards.Required Qualifications
High School Diploma or GED (verifiable)Active Pharmacy Technician License (state or national certification) in good standingMinimum 1 year of healthcare experience as a pharmacy technician or in a comparable roleExperience in a high-volume call center environment (preferably healthcare-related)Strong computer skills, including proficiency with word processing and spreadsheetsExcellent verbal and written communication skillsPreferred Qualifications
Prior authorization or PBM (Pharmacy Benefit Management) experienceAdditional Information
Remote : 100% work from home (no onsite requirements)