Jobs
>
Tampa

    Senior Pharmacy Resolution Specialist - Tampa, United States - Centene Corporation

    Centene Corporation
    Centene Corporation Tampa, United States

    1 week ago

    Default job background
    Full time
    Description

    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.

    Senior Pharmacy Resolution Specialist - Remote - 12pm – 8:30pm (EST) M-F

    Position Purpose: The Senior Pharmacy Resolution Specialist will act as a subject matter expert and handles more complex pharmacy issues and respond to escalated calls from members, provider/physician's offices and pharmacies. This role will make outbound calls and enters pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists.

    • Takes member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests. Offers options including submission of a prior authorization request. Thoroughly researches issues and takes appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards
    • Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims (i.e.: additional information requests and medication determination updates)
    • Thoroughly researches issues and takes appropriate action to resolve them within turnaround time requirements and quality standards
    • Assists team members often guiding them to the appropriate resolution of more complex and difficult inquiries. Participates in the training of less experienced staff, including opportunity for job shadowing
    • Acts as a liaison between internal departments on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility. Presents proposed solutions in a clear and concise manner.
    • Assists with audit preparation as needed
    • Assists with miscellaneous special project work as assigned

    Education/Experience: High School Diploma / GED
    2 years of experience
    Call center / customer service experience
    Experience in healthcare environment (pharmacy operations, managed care, pharmacy hospitals and or pharmacy retail settings)

    License/Certification: Pharmacy technician certification preferred

    Shift: 12:00pm-8:30pm M-F

    Pay Range: $ $31.73 per hour

    Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which 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.

  • Acosta

    Claims Resolution Specialist

    1 week ago

    Acosta Tampa, United States

    Job Description · The Claims Resolution Specialist is responsible for validating and clearing claims against promotional offers, analyzing claims to determine their validity, and clearing claims in accordance with Acosta, client and customer policies and procedures. The Claims R ...

  • Acosta Group

    Claims Resolution Specialist

    5 days ago

    Acosta Group Tampa, United States

    **DESCRIPTION** · The Claims Resolution Specialist is responsible for validating and clearing claims against promotional offers, analyzing claims to determine their validity, and clearing claims in accordance with Acosta, client and customer policies and procedures. The Claims R ...

  • Acosta Group

    Claims Resolution Specialist

    1 week ago

    Acosta Group Tampa, United States

    **RESPONSIBILITIES** · + Trains and mentors Claim associates on validating and clearing claims in accordance with Acosta, client and customer policies and procedures. · + Assumes supervisory responsibilities in the absence of the Claims Resolution Supervisor · + Assists the Cl ...

  • GTE Financial

    Mortgage Resolution Specialist

    2 weeks ago

    GTE Financial Tampa, United States Full time

    Come join our GTE Financial team · We are looking for an organized, professional, strategic individual to join as a Mortgage Resolution Specialist. Mortgage Resolution Specialist is responsible in providing evaluation of delinquency/loss of loans to determine/implement appropria ...

  • Acosta Group

    Claims Resolution Specialist

    1 week ago

    Acosta Group Tampa, United States

    **RESPONSIBILITIES** · + Trains and mentors Claim associates on validating and clearing claims in accordance with Acosta, client and customer policies and procedures. · + Assumes supervisory responsibilities in the absence of the Claims Resolution Supervisor · + Assists the Cl ...

  • Tampa General Hospital

    Claims Resolution Specialist 2

    1 week ago

    Tampa General Hospital Tampa, United States

    Responsible for prompt and accurate follow-up of all unpaid claims. Reviews assigned accounts to determine appropriate action needed with regards to claim resolution. Handles large payer projects as assigned by Department Manager. Responsible for 2nd Claims, Specialist, Healthcar ...

  • USF Health

    Claims Resolution Specialist 1

    4 days ago

    USF Health Tampa, United States

    Job Summary: · Responsible for prompt and accurate submission and follow-up of all third party claims. Reviews assigned accounts perform status inquiry and appeals to 3rd party payers to ensure reimbursement. Reviews assigned accounts, determines appropriate action to resolve ou ...

  • USF Health

    Claims Resolution Specialist 1

    1 week ago

    USF Health Tampa, United States

    University of South Florida Tampa General Physicians (USFTGP) was created through an advanced affiliation between The University of South Florida and Tampa General Hospital to provide advanced care to patients and their families throughout Florida. Specialties include cardiology, ...

  • The Tampa General Hospital Foundation Inc

    Claims Resolution Specialist 1

    3 days ago

    The Tampa General Hospital Foundation Inc Tampa, United States

    University of South Florida Tampa General Physicians (USFTGP) was created through an advanced affiliation between The University of South Florida and Tampa General Hospital to provide advanced care to patients and their families throughout Florida. Specialties include cardiology, ...

  • Tampa General Hospital

    Claims Resolution Specialist 1

    6 days ago

    Tampa General Hospital Tampa, United States

    Responsible for prompt and accurate submission and follow-up of all third party claims. Reviews assigned accounts perform status inquiry and appeals to 3rd party payers to ensure reimbursement. Reviews assigned accounts, determines appropriate action Claims, Specialist, Healthcar ...

  • Mid Atlantic Finance Company

    Resolution Specialist

    4 days ago

    Mid Atlantic Finance Company Clearwater, United States

    Immediate need for a Resolution Specialist$500 Signing Bonus after 90 daysSalary: hourly rate plus monthly bonus incentiveSchedule: Monday Friday 8:00 am-5:00 pm OR 8:30 am-5:30 pmOverview:We are currently expanding our Repossession team in order to service accounts across the Un ...

  • Mid Atlantic Finance Company

    Resolution Specialist

    5 days ago

    Mid Atlantic Finance Company Clearwater, United States

    Immediate need for a Resolution Specialist · $500 Signing Bonus after 90 days · Salary: hourly rate plus monthly bonus incentive · Schedule: Monday · Friday 8:00 am-5:00 pm OR 8:30 am-5:30 pm · Overview: · We are currently expanding our Repossession team in order to service acco ...

  • Mid Atlantic Finance Company

    Resolution Specialist

    2 days ago

    Mid Atlantic Finance Company Clearwater, United States

    Immediate need for a Resolution Specialist · $500 Signing Bonus after 90 days · Salary: hourly rate plus monthly bonus incentive · Schedule: Monday – Friday 8:00 am-5:00 pm OR 8:30 am-5:30 pm · Overview: · We are currently expanding our Repossession team in order to service ...

  • Global Channel Management

    Claims Resolution Specialist

    1 week ago

    Global Channel Management Dunedin, United States

    Experienced Admin Processor Opportunity Available · Qualifications · Minimum of 1+ years of data entry experience · Ability to handle multiple tasks efficiently · Proficient in accurate claims processing and follow-up procedures · Strong communication and customer service skill ...

  • J.W. Cole Financial, Inc.

    Sales Support Specialist

    2 weeks ago

    J.W. Cole Financial, Inc. Tampa, United States

    **J.W. Cole Company Profile** · J.W. Cole is a Tampa-based Broker-Dealer and Registered Investment Adviser providing robust service, operational, product, compliance, and practice support to approximately 500 Financial Professionals nationwide. At J.W. Cole, we recognize that we ...

  • Rocket Pest

    Collections Specialist

    1 week ago

    Rocket Pest Tampa, United States

    **Rocket Pest Control is an out of this world company looking for the best people to help us be the trusted choice in pest control** · Our **Mission **is to protect customer's homes, families and businesses by delivering safe, convenient and reliable pest control solutions. We ar ...

  • St. Vincent de Paul CARES

    Housing Specialist I

    1 week ago

    St. Vincent de Paul CARES Tampa, United States

    **MISSION STATEMENT**: To be a beacon of light by transforming lives in the Vincentian spirit of charity, justice, and mercy through interpersonal connectivity. · **SUMMARY**: The Housing Specialist I shall provide direct services to enable eligible clients to locate affordable, ...

  • Liberty Mutual

    Workers Compensation Claims Specialist

    1 week ago

    Liberty Mutual Tampa, United States

    **Pay Philosophy** · The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in the ...

  • Bausch + Lomb

    Compliance Specialist

    11 hours ago

    Bausch + Lomb Tampa, United States

    **Bausch + Lomb (NYSE/TSX**: BLCO) is a leading global eye health company dedicated to protecting and enhancing the gift of sight for millions of people around the world—from the moment of birth through every phase of life. Our mission is simple, yet powerful: helping you see bet ...

  • Charter School Associates

    Ese Teacher

    1 week ago

    Charter School Associates Tampa, United States

    **Channelside Academy of Math & Science** (CAMS) is a tuition-free public charter school serving the downtown Tampa and greater Tampa Bay community for students Grade K-8. CAMS is part of Charter School Associates, a growing network of 23 public charter schools located throughout ...