Pharmacy Technician

Responsibilities

• Verify eligibility and drug coverage under plan benefit designs for claims processing.
• Triage clinical review of prior authorization requests according to established protocols.
• Review prior authorization requests using criteria, claims history, and benefit rules; contact prescribers and pharmacies to gather required information.
• Organize and prioritize requests to ensure timely case management.
• Build and adjust authorizations in the claims adjudication system.
• Apply pharmacy technician knowledge of drug products and formulations and perform basic calculations to monitor accurate claims adjudication.
• Synthesize multiple workflows and protocols to make sound coverage decisions.
• Coordinate with internal teams and external stakeholders, address questions and escalations, and support timely medication coverage.
• Evaluate member clinical situations against medication policies and approve requests or triage them to a pharmacist for denial.
• Determine when medications require internal or external review.
• Contact select external stakeholders for approval of drugs with dollar limits.

Requirements

• High school diploma, GED, or equivalent work experience.
• Active pharmacy technician license.
• 2–4 years of pharmacy technician experience.
• Proficiency with Mac, Microsoft Office, and Google Workspace.
• Strong critical-thinking, communication, active-listening, empathy, multitasking, prioritization, and time-management skills.
• Ability to work accurately within protocols and follow escalation pathways.

Nice-to-haves

• 2+ years of prior authorization review experience on the approval side at a PBM or health plan.

Compensation

• $22 per hour USD.
• Benefits may include bonuses, commissions, equity, paid time off, medical, dental, vision, mental health support, paid parental leave, life and disability insurance, and a 401(k).