Pharmacy Prior Authorization Call Center Representative (Remote - Connecticut)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

The Pharmacy Prior Authorization Call Center Representative will service the Connecticut Medicaid account. This fast-paced position is responsible for addressing pharmacy claims and prior authorization questions from prescribers and pharmacies. The representative will work as part of an 8-member team and is required to process all pharmacy prior authorizations within 2 hours of receipt. This position also requires on-call responsibilities and the flexibility to work second or third shifts on a rotational basis.

Your role in our mission

• Answer basic and complex pharmacy-related inquiries from prescribers and providers.
• Analyze pharmacy claims to provide timely responses to provider inquiries.
• Verify and explain pharmacy benefits to providers and document each call accurately.
• Process prior authorization requests, recording approval or denial details and rationale.
• Maintain timely processing of all pharmacy prior authorizations within the 2-hour window.
• Assist with additional tasks and duties as assigned to support team objectives.

What we're looking for

• Knowledge of pharmacy claims and dispensing systems.
• Ability to work efficiently in a fast-paced environment and handle multiple tasks simultaneously.
• Strong understanding of Medicare Part D, Medicaid, or other state pharmaceutical programs (preferred).
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook), including managing personal and team mailboxes.
• Excellent verbal and written communication skills with strong organizational and problem-solving abilities.
• Ability to work independently within a team environment with little supervision.
• Knowledge of HIPAA regulations and experience maintaining confidentiality.

What you should expect in this role

• Fully remote position, but you must reside in Connecticut.
• The call center operates 24/7, 365 days a year, with core staffing Monday through Friday from 7:30 AM to 7:30 PM and rotating shifts on Saturdays from 9 AM to 4 PM. All other hours are covered through an on-call rotation.
• You will be part of a dedicated team responsible for ensuring timely and accurate processing of pharmacy prior authorizations and handling complex inquiries.
• On-call and flexible shifts are required based on business needs.

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The pay range for this position is $33,500.00 - $47,900.00 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.