Pharmacy Specialist l

Why consider this job opportunity:

• Salary up to $59,745
• Comprehensive health benefits (Medical/Dental/Vision)
• Generous PTO and paid volunteer time off
• Opportunities for career advancement and professional development
• Incentive plans and wellness programs to support overall well‑being
• Collaborative and innovative work environment

• Manage all telephonic interactions with members, physician office staff, and pharmacies regarding Pharmacy eligibility and coverage determinations
• Engage with physicians and pharmacists to facilitate formulary compliance and optimize generic dispensing
• Capture comprehensive clinical information for Prior Authorization requests to support medical necessity evaluations
• Ensure compliance with all departmental quality metrics and regulatory turnaround times
• Identify potential fraud, waste, and abuse during interactions with members and providers, making necessary internal referrals

• High School Diploma/GED required
• Minimum of two (2) years of experience as a Pharmacy Technician
• Experience in customer service/service quality initiatives
• National Pharmacy Technician Certification (PTCB or ExCPT) required
• Knowledge of popular brand and generic drug names and third‑party prescription program claim adjudication

• Minimum of two (2) years of experience in third‑party prescription program claim adjudication
• Experience in managed care or a Pharmacy Benefit Management (PBM) organization
• Proven time management skills and ability to manage multiple priorities effectively
• Strong communication skills with the ability to convey technical information clearly
• Demonstrated ability to work in a production‑focused environment

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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top‑tier employer.