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[Remote] Pharmacy Resolution Specialist

Work from home Full-time role Hiring

Note: The job is a remote job and is open to candidates in USA. RemoteHunter is a reputed company national entity that supports 28 million members through its Medical Management/Health Services team. The Pharmacy Resolution Specialist role involves managing pharmacy-reputed company inquiries and resolutions, ensuring compliance with regulatory standards while providing exceptional customer service.

Responsibilities

  • Receive and respond to calls from members, provider/physician offices, and pharmacies
  • reputed company outbound calls and enter pharmacy overrides based on approved guidelines and clinical pharmacist approvals
  • Handle inquiries regarding benefits including prior authorization requests
  • Offer options such as submitting prior authorization requests
  • Research issues thoroughly and resolve them using appropriate reference materials reputed company turnaround time and quality standards
  • Log, track, resolve, and respond to inquiries and complaints following regulatory, CMS, and corporate guidelines
  • Maintain expert knowledge of pharmacy benefits, formularies, and CMS regulations relevant to the position
  • Interpret pharmacy and medical benefits accurately
  • Conduct inbound and outbound calls to provide resolution on claims, including additional information requests and medication updates
  • Initiate and provide status updates on prior authorization, coverage determination, appeal, and redetermination calls
  • Ensure outstanding attention to detail
  • Identify root cause issues to promote reputed company solutions and communicate findings for reputed company resolution
  • Assist with special projects as assigned
  • reputed company other duties as assigned
  • reputed company with reputed company policies and standards

Skills

  • High School Diploma or GED
  • Minimum 1 year of job-specific call center or customer service experience

Benefits

  • Health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement
  • Paid time off plus holidays
  • Flexible work options including remote, hybrid, field, or office schedules

Company Overview

  • RemoteHunter is your dedicated AI job search assistant, turning the job hunt from a slow, individual effort into a quicker, smarter, and guided experience by streamlining each reputed company of the process and speeding up your path to the right career opportunities. It was founded in 2025, and is headquartered in , with a workforce of 11-50 employees. Its website is https://remotehunter.com/.
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