Pharmacy Resolution Specialist at Centene

You are an organized professional with at least one year of call center or customer service experience and a high school diploma or GED. You thrive in high volu

Work type: remote

Location: Remote-FL

Salary: $16 – $27/hr

Type: Full-time

Summary

You are an organized professional with at least one year of call center or customer service experience and a high school diploma or GED. You thrive in high volume environments and have a solid grasp of medical or pharmacy terminology. **What makes it worth a look...** Centene offers a pay range of $15.87 to $27.25 per hour for this fully remote role based in Florida. You must be available to work the evening shift from 2:00PM to 10:30PM EST to manage member inquiries and pharmacy benefit resolutions. **You might be a good fit if you...** * Possess at least one year of direct call center or customer service experience. * Can navigate pharmacy benefits, formularies, and prior authorization requirements. * Maintain the ability to work a fixed 2:00PM to 10:30PM EST schedule. * Are comfortable handling high volumes of inbound and outbound calls.

Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Qualified candidates must be able to work 2:00PM-10:30PM EST. The targeted start date for this role is 5/18/26*Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.Position Purpose: The Pharmacy Resolution Specialist receives and responds to calls from members, provider/physician's offices, and pharmacies. This role makes outbound calls and enters pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists.

• Takes member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests

• Offers options including submission of a prior authorization request

• Thoroughly researches issues and takes appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards

• Logs, tracks, resolves, and responds to all assigned inquiries and complaints while meeting all regulatory, CMS, and Centene Corporate guidelines in which special care is required to enhance Centene relationships, while meeting and exceeding all performance standards

• Maintains expert knowledge on all pharmacy benefits and formularies, including CMS regulations as they pertain to this position

• Responsible for knowing and interpreting pharmacy and medical benefits

• Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims (i.e.: additional information requests and medication determination updates)

• Actively involved in the initiation and providing status for prior authorization/coverage determination, appeal / redetermination phone calls

• Responsible for ensuring outstanding attention to detail

• Identify root cause issues to ensure enterprise solutions and communicate findings as needed to ensure first call resolution

• Assists with special projects as assigned


• Performs other duties as assigned

• Complies with all policies and standards

Pay Range: $15.87 - $27.25 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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