Pharmacy Resolution Specialist

Job Description

Location: Work From Home – Must Reside in Orlando, FL

TalentLNX is hiring a Pharmacy Resolution Specialist on behalf of a leading national healthcare organization. This full-time, work from home position is ideal for individuals with pharmacy support or call center experience who are passionate about helping patients access their medications and understand their pharmacy benefits.

Please Note: Candidates must reside within a commutable distance to Orlando, FL, to attend quarterly training sessions and team events.

Responsibilities:

• Member & Provider Support: Handle inbound and outbound calls from members, physicians, and pharmacies related to benefit inquiries and medication access.
• Claims & Authorization Navigation: Provide accurate information on pharmacy coverage, formulary options, prior authorizations, and medication determinations.
• Override Processing: Enter pharmacy overrides into internal systems based on pharmacist approvals and company guidelines.
• Issue Resolution: Investigate and resolve complex benefit concerns while meeting turnaround time and compliance standards.
• Documentation: Accurately log all activity and correspondence to meet regulatory, CMS, and internal quality requirements.
• First-Call Resolution: Identify root causes and collaborate with internal teams to proactively solve recurring access issues.
• Special Projects: Support department initiatives and process improvements as assigned.

Work Environment:

This is a work from home role with a highly structured workflow. The position requires strong attention to detail, comfort with multi-system navigation, and a high level of accountability in handling sensitive pharmacy benefit data.

Qualifications:

• High school diploma or GED required
• Minimum of 2 years experience in a call center, healthcare support, or pharmacy benefit setting
• Familiarity with pharmacy claims, prior authorizations, and coverage determinations preferred
• Excellent verbal communication, problem-solving, and documentation skills
• Proficient in navigating multiple systems and adhering to regulatory timelines
• Ability to work independently in a remote, performance-driven environment
• Reside in the Orlando, FL area

Schedule 

• Full-time – Work From Home
• Monday – Friday shifts between 8:00 AM – 5:00 PM EST

Salary Range: Compensation for this role ranges from $40,000 to $55,000 per year (approximately $19.00 to $26.00 per hour), depending on experience and qualifications.

Interview Process:

• Initial Screening – TalentLNX Recruiting Team
  A 20–30 minute introductory phone call to discuss your background, access-related experience, and what you’re looking for in your next opportunity. We’ll provide more detail about the role, clarify expectations, and ensure alignment on factors like compensation, travel, and team structure.

• First Interview – Member Services Supervisor (Phone Interview)
  A phone conversation with a department supervisor focused on your experience resolving pharmacy benefit inquiries, handling escalations, and navigating claims or prior authorization processes.

• Final Interview – Video Call with Clinical Operations and Quality Assurance Leaders
  A virtual interview with key decision-makers from Clinical Operations and QA leadership. This conversation will assess your communication style, problem-solving approach, and attention to compliance, accuracy, and service standards.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds, and we encourage all qualified candidates to apply for our job opportunities.