Senior Pharmacy Resolution Specialist

Position Overview You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Work Hours : 8am-6:30pm EST. Targeted start date: 8/10/26. Must be authorized to work in the U.S. without the need for employment‑based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment‑based visa types H‑1B, L‑1, O‑1, H‑1B1, F‑1, J‑1, OPT, or CPT. Position Purpose The Senior Pharmacy Resolution Specialist will act as a subject matter expert and handle more complex pharmacy issues, responding to escalated calls from members, provider/physician's offices, and pharmacies. Responsibilities Make outbound calls and enter pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists. Respond to prior authorization requests and provide options including submission of a prior authorization request. Research issues and take appropriate action to resolve them using reference materials within turnaround time requirements and quality standards. Conduct inbound and outbound calls with members and provider offices to provide resolution to claims, such as additional information requests and medication determination updates. Assist team members in guiding them to appropriate resolution of more complex and difficult inquiries. Participate in training of less experienced staff, including job shadowing opportunities. Act as liaison between internal departments on data gathering and problem solving while investigating unusual problems. Present proposed solutions in a clear and concise manner. Assist with audit preparation and miscellaneous special project work as assigned. Perform other duties as assigned. Qualifications High School Diploma or GED. 2 years of experience in call center / customer service. Experience in a healthcare environment (pharmacy operations, managed care, pharmacy hospitals, or pharmacy retail settings). License & Certification Pharmacy technician certification preferred. Compensation & Benefits Hourly rate: $19.43 - $32.98 per hour, adjusted based on skills, experience, education, and other job‑related factors. Comprehensive benefits: health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays. Flexible work approach: remote, hybrid, field, or office schedules. Equal Opportunity Centene is an equal opportunity employer that is committed to diversity and values the ways we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act. #J-18808-Ljbffr