Centene Management Company LLC is hiring a Senior Pharmacy Resolution Specialist to act as a subject matter expert resolving complex pharmacy issues. You will handle escalated calls from members, physicians, and pharmacies, making outbound calls and entering pharmacy overrides per approved guidelines.
What You'll Do
- Take member, prescriber, and pharmacist inquiry calls for benefit questions and prior authorization requests.
- Offer options including submission of a prior authorization request.
- Thoroughly research issues and take appropriate action to resolve them within turnaround time and quality standards.
- Answer and conduct inbound and outbound calls with members and provider offices to resolve claims.
- Assist and guide team members on the resolution of more complex and difficult inquiries.
- Participate in training less experienced staff, including job shadowing.
- Act as a liaison between internal departments for data gathering and problem solving.
- Present proposed solutions clearly and concisely.
- Assist with audit preparation and special project work as assigned.
- Perform other duties as assigned and comply with all policies and standards.
What We're Looking For
- High School Diploma / GED
- 2 years of relevant experience
- Call center or customer service experience in a healthcare environment (pharmacy operations, managed care, pharmacy hospitals, or pharmacy retail settings)
Nice to Have
- Pharmacy technician certification
Benefits & Compensation
- Hourly rate: $19.04 - $32.35
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
Work Mode
This is a remote position open to candidates located anywhere in the United States.
Centene is an equal opportunity employer that is committed to diversity. 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.
