Pharmacy CSR, Remote

About Our Client

The organization operates within the healthcare sector, focusing on pharmacy-related services for Medicaid and Marketplace members. It addresses challenges related to medication management, utilization management, and prior authorizations in a pharmacy call center environment. The program aims to optimize medication-related healthcare outcomes while ensuring quality and cost-effective care for members.

About the Opportunity

The Pharmacy Customer Service Representative role is responsible for handling inbound and outbound pharmacy calls from members, providers, and pharmacies. This position supports pharmacy utilization management and prior authorization processes, contributing to efficient medication access and member satisfaction. The role directly impacts the quality of service delivery in the pharmacy call center by ensuring clear communication and effective resolution of pharmacy-related inquiries.

Responsibilities

• Provide exceptional, compassionate customer service support for high-volume inbound and outbound pharmacy calls from members, healthcare providers, and retail pharmacies
• Manage and intake pharmacy prior authorization requests, coverage determinations, and formal clinical appeals processes
• Explain complex drug claims adjudication, rejection codes, and relevant plan policies clearly to all stakeholders
• Perform essential administrative and clerical tasks related to daily pharmacy call center operations and document management
• Communicate plan benefit details accurately, including structural formulary tiers, drug restrictions, and specific copay structures
• Aid members and prescribing providers through the comprehensive coverage determination, exception, and appeals workflows
• Record and log all call interactions, verification points, and outcomes accurately within the designated tracking systems
• Maintain and exceed strict pharmacy call quality benchmarks, compliance protocols, and volume quantity standards
• Cook up direct with primary care providers (PCPs) to update internal member registries and medication records
• Support clinical pharmacists in compiling patient documentation and preparing comprehensive medication reviews (CMR)
• Identify, document, and suggest strategic opportunities to improve pharmacy call center member relations and retention

Requirements

• Minimum of one (1) year of related professional experience, including call center operations, retail pharmacy support, or healthcare customer service
• Excellent interpersonal, active listening, and verbal/written communication skills
• Proven ability to multitask, navigating multiple database applications and electronic health records simultaneously while speaking on the phone
• Strong capability to work independently, manage a high-volume task queue, and balance multiple project assignments
• Foundational technical proficiency within the Microsoft Office Suite and comfort learning specialized pharmacy benefit management (PBM) software
• Ability to develop positive, collaborative working relationships with various internal teams, providers, and external stakeholders
• High degree of patience and professional etiquette suited for explaining complex medical and drug coverage guidelines to diverse populations

Pay Range and Compensation Package

The target hourly wage or salary for this specialized pharmacy support role is highly competitive and will be determined dynamically based on the final candidate's depth of pharmacy call center experience, medical terminology knowledge, and localized geographic market data. A comprehensive perks and benefits overview—including standard medical insurance options, retirement plan matching paths, flexible work allowances, and paid time off structures—will be shared transparently during the initial screening conversation.

Equal Opportunity Statement

Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note: RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.