[Remote] Pharmacy Resolution Specialist

Note: The job is a remote job and is open to candidates in USA. RemoteHunter is a diversified national entity that supports 28 million members through its Medical Management/Health Services team. The Pharmacy Resolution Specialist role involves managing pharmacy-related inquiries and resolutions, ensuring compliance with regulatory standards while providing exceptional customer service.ResponsibilitiesReceive and respond to calls from members, provider/physician offices, and pharmaciesMake outbound calls and enter pharmacy overrides based on approved guidelines and clinical pharmacist approvalsHandle inquiries regarding benefits including prior authorization requestsOffer options such as submitting prior authorization requestsResearch issues thoroughly and resolve them using appropriate reference materials within turnaround time and quality standardsLog, track, resolve, and respond to inquiries and complaints following regulatory, CMS, and corporate guidelinesMaintain expert knowledge of pharmacy benefits, formularies, and CMS regulations relevant to the positionInterpret pharmacy and medical benefits accuratelyConduct inbound and outbound calls to provide resolution on claims, including additional information requests and medication updatesInitiate and provide status updates on prior authorization, coverage determination, appeal, and redetermination callsEnsure outstanding attention to detailIdentify root cause issues to promote enterprise solutions and communicate findings for first call resolutionAssist with special projects as assignedPerform other duties as assignedComply with all policies and standardsSkillsHigh School Diploma or GEDMinimum 1 year of job-specific call center or customer service experienceBenefitsHealth insurance401K and stock purchase plansTuition reimbursementPaid time off plus holidaysFlexible work options including remote, hybrid, field, or office schedulesCompany OverviewRemoteHunter 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 step 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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