Senior Pharmacy PA/Appeals Technician

About the role

The Senior Pharmacy PA/Appeals Technician role supports the prior authorization and appeals process by providing accurate, timely, and professional service to members, providers, pharmacists, and internal business partners.

Responsibilities

• Manage a high volume of inbound and outbound calls, averaging 50+ daily, while maintaining professionalism, accuracy, and customer service expectations
• Respond to prior authorization inquiries and requests from providers, pharmacies, members, and internal partners using approved scripts, reference materials, job aids, policies, and procedures
• Review and process prior authorization requests through multiple computer systems, ensuring required information is complete, accurate, and documented in accordance with compliance, regulatory, client, and business requirements
• Research formulary, benefit, medication, eligibility, and plan-specific information to help resolve prior authorization questions, benefit issues, and case-processing barriers
• Gather and verify member, provider, prescriber, pharmacy, medication, diagnosis, and clinical support information needed for pharmacist consultation or clinical review
• Identify missing or incomplete information and take appropriate follow-up action, including outbound calls or routing to the appropriate team, pharmacist, or clinician when needed
• Prioritize work to support required turnaround times for standard, expedited, urgent, and client-specific prior authorization requests
• Maintain productivity, quality, schedule adherence, attendance, and documentation standards in a fast-paced, metric-driven environment
• Resolve issues and complaints in a timely, professional manner and escalate concerns when additional support, clinical review, or leadership guidance is required

Qualifications

• Active and unrestricted Pharmacy Technician licensure, registration, or certification as required by the state of residence and business needs
• Candidates must meet and maintain all applicable state, certification, and company requirements throughout employment
• Experience with prior authorization, appeals, pharmacy benefit management, prescription drug benefits, formulary review, pharmacy claims, or healthcare coverage processes
• Knowledge of Medicare Part D, commercial, Medicaid, exchange, or client-specific pharmacy benefit requirements
• Experience working in a high-volume, production-based, quality-monitored, or compliance-driven environment
• Familiarity with pharmacy terminology, medication names, brand and generic drug names, SIG codes, benefit terminology, and healthcare documentation standards

Benefits

Primary benefits include competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include paid time off, medical plans, dental, vision, life & AD&D insurance, short-term and long-term disability coverage, a 401(k) savings plan, employee stock purchase plan, education reimbursement, employee discounts, employee assistance program, employee referral bonus program, voluntary benefits, and more. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.