[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. Responsibilities Receive and respond to calls from members, provider/physician offices, and pharmacies Make 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 within 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 enterprise solutions and communicate findings for first call resolution Assist with special projects as assigned Perform other duties as assigned Comply with all 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 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