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Senior Certified Pharmacy Technician - Remote US

Role overview

Qualifications

  • Active and current Certified Pharmacy Technician (CPhT) credential
  • Minimum of 2 years of call center experience, preferably in a healthcare or PBM environment
  • Minimum of 2 years of PBM experience, including knowledge of formulary management, pharmacy claims adjudication, and benefit interpretation
  • Strong verbal and written communication skills, computer proficiency, attention to detail, and the ability to work across multiple systems in a fast-paced, high-volume environment

Responsibilities

  • Provide advanced support to members, prescribers, and pharmacy providers through various communication channels
  • Research and resolve complex pharmacy benefit inquiries, including pharmacy claims, claim rejections, formulary questions, and medication access issues
  • Support and coordinate prior authorization processes and ensure accurate handling of pharmacy-related requests
  • Assist team members with escalated issues and contribute to quality and process improvement initiatives

Key facts

Hard skills

Other skills

  • Communication
  • Detail Oriented
  • Computer Literacy
  • Teamwork
  • Problem Solving
  • Adaptability

About the company

Gainwell Technologies LLC logo

Gainwell Technologies LLC

Digital Health & Health Tech

For 50 years, our nation’s federal Medicaid program has worked to improve the health, safety and well-being of America’s most vulnerable populations: low-income families, women and children, seniors, and those with disabilities. With positive health and cost outcomes that pierce inequities and impact economies, the success of these programs is inextricably tied to the prosperity of communities, individual states and the nation as a whole. We think that demands respect and, more importantly, is deserving of a lifetime commitment from innovators who can help those who operate within and around health and human services evolve — in any market at any stage. At Gainwell Technologies, that’s our sole focus. Built across more than five decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet agencies, health plans and MCOs where they are on their modernization journeys and propel them into the future of public health. Our commitment to innovation, deep experience and ability to leverage insights from customers across 50 states has allowed us to expand on next-generation, cloud-enabled technologies. Today, Gainwell offers one of the most comprehensive suites of scalable services and solutions on the market — all proven to deliver cost savings, better patient outcomes and an improved provider experience. Equally important to our expanding technologies and results: We bring ideas that bring policies to life.

Company details

Company typeLarge
IndustryDigital Health & Health Tech
Company size10001

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Job description

 

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

Summary

As a Senior Certified Pharmacy Technician in Gainwell’s Pharmacy Benefits Management (PBM) Clinical and Technical Call Center, you’ll serve as a subject matter expert supporting members, medical providers, and pharmacy providers with complex pharmacy benefit questions and medication access needs.

You’ll use your advanced pharmacy knowledge and PBM experience to resolve complex inquiries, support escalated issues, assist team members, and help ensure accurate and timely service across multiple communication channels, including phone, fax, email, and web-based platforms.

Your role in our mission

  • Provide advanced support to members, prescribers, and pharmacy providers through phone, fax, email, and web-based communication channels.
  • Research and resolve complex pharmacy benefit inquiries, including pharmacy claims, claim rejections, formulary questions, benefit interpretation, and medication access issues.
  • Support and coordinate prior authorization processes and help ensure pharmacy-related requests are handled accurately and within established guidelines.
  • Serve as a subject matter expert for team members by assisting with escalated issues, sharing pharmacy and PBM knowledge, and supporting training and onboarding activities.
  • Contribute to quality and process improvement initiatives while meeting established service, productivity, compliance, and customer experience standards.

What we're looking for

  • Active and current Certified Pharmacy Technician (CPhT) credential.
  • Minimum of 2 years of call center experience, preferably in a healthcare or PBM environment.
  • Minimum of 2 years of PBM experience, including knowledge of formulary management, pharmacy claims adjudication, and benefit interpretation.
  • Strong knowledge of pharmacy claims processing and claim rejection resolution, with experience supporting or coordinating prior authorization decisions.
  • Strong verbal and written communication skills, computer proficiency, attention to detail, and the ability to work across multiple systems in a fast-paced, high-volume environment.

Previous leadership experience, retail pharmacy or PBM call center experience, familiarity with pharmacy management systems, and bilingual skills are preferred.

What you should expect in this role

  • This is a 100% remote position requiring a reliable high-speed internet connection and a private, quiet workspace suitable for handling confidential information.
  • Candidates must comply with company technology, information security, and HIPAA requirements while using company-provided equipment.
  • Must successfully complete required virtual onboarding and training and be comfortable with extended computer and headset use in a call center environment.
  • Must be available to work assigned shifts based on business needs. Schedules may include first, second, or third shift, including evenings, overnights, weekends, or holidays.
  • Candidates must complete a skills and competency assessment before advancing to the next stage of the selection process.

Candidates must reside in an approved state for remote employment as defined by company policy.

This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis.

#LI-REMOTE

#LI-JT1

The pay range for this position is $33,500 - $47,900 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

 

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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