Care & Resolution Specialist

Job not on LinkedIn

🔥 16 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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EmpiRx Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2014

🏥 Healthcare

💊 Pharmaceuticals

⚕️ Healthcare Insurance

Healthcare • Pharmaceuticals • Healthcare Insurance

EmpiRx Health is a clinically-driven, pharmacist-led pharmacy benefits management (PBM) company that focuses on medication optimization and value-based pharmacy care. The company centers pharmacists in its operating model, leveraging AI-powered analytics and population health tools to make evidence-based medication recommendations, improve patient outcomes, and reduce total drug spending for plan sponsors. EmpiRx offers a technology-enabled PBM platform and services to employers, health plans, and pharmacies, emphasizing customer-first service, guaranteed clinical savings, and preservation of community pharmacies.

📋 Description

• Respond promptly and professionally to inbound member calls and inquiries • Monitor and enforce adherence to daily processes, protocols, and escalation pathways • Serve as an administrative liaison between members, internal departments, pharmacies, and prescribers • Manage and resolve cases involving prescription claims, authorizations, and pharmacy benefit concerns • Document outcomes according to departmental standards • Develop effective and sustainable solutions for member issues • Support urgent or emergency override situations following defined protocols • Maintain knowledge of pharmacy benefit workflows, including mail order, specialty pharmacy, prior authorization, accumulator management, and cost containment programs • Understand claims adjudication procedures, plan setup, and client-specific benefit allowances • Identify root causes of member issues and recommend process improvements • Stay current on company programs, products, and processes • Collaborate with Clinical, Client Management, and Operations departments • Build trust and rapport with members through clear communication, transparency, and follow-up • Maintain accurate records in the member services system • Participate in team huddles, performance reviews, and training sessions • Perform additional duties as assigned

🎯 Requirements

• Bachelor’s degree preferred • Minimum 2 years of experience in a PBM, health plan, or medication therapy management (MTM) call center; or 4 years of experience in a hospital or retail pharmacy setting • At least 2 years of experience in a customer service-related field, preferably within healthcare or pharmacy • Active Pharmacy Technician Certification (CPhT) required • Prior experience with benefit investigations, prior authorizations, or claims processing preferred • Strong customer service orientation with a commitment to concierge-level support • Excellent verbal and written communication skills with active listening and empathy • Proficiency in Microsoft Office Suite and related systems (CRM, ticketing, or case management tools) • Ability to think critically, problem-solve, and make sound decisions under pressure • Exceptional time management and organizational skills; able to manage multiple priorities in a fast-paced environment • Collaborative mindset with the ability to work cross-functionally to ensure resolution and client satisfaction

🏖️ Benefits

• Paid Time Off • 401(k) program • Health Insurance including Dental & Vision coverage • Health Savings Account • Employee Assistance Program