[Hiring] Care & Resolution Specialist @EmpiRx Health, LLC

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Care & Resolution Specialist supports EmpiRx Health’s commitment to delivering white-glove, clinically driven member experiences by serving as the primary point of contact for complex member inquiries. This role ensures prompt, compassionate, and accurate resolution of escalated concerns within Level 2 Member Services. The incumbent demonstrates strong critical thinking, clinical awareness, and empathy in every interaction, working collaboratively across internal teams, pharmacies, and prescribers to ensure a seamless, concierge-level service experience. • Respond promptly and professionally to inbound member calls and inquiries, ensuring each interaction is handled with empathy and precision. • Monitor and enforce adherence to established daily processes, protocols, and escalation pathways. • Serve as an administrative liaison between members, internal departments, and external partners (e.g., pharmacies, prescribers) to facilitate accurate and timely issue resolution. • Manage and resolve cases related to prescription claims, authorizations, and other pharmacy benefit concerns, documenting outcomes in accordance with departmental standards. • Apply sound judgment and empathy to develop effective and sustainable solutions for member issues. • Support urgent or emergency override situations as necessary, following defined protocols. • Maintain comprehensive knowledge of pharmacy benefit workflows, including mail order, specialty pharmacy, prior authorization, accumulator management, and cost containment programs. • Demonstrate understanding of claims adjudication procedures, plan setup, and client-specific benefit allowances. • Use analytical and critical thinking skills to identify root causes of member issues and recommend process improvements. • Stay current on EmpiRx Health program updates, products, and processes to ensure accurate and compliant communication with members. • Foster collaboration with internal EmpiRx Health departments (e.g., Clinical, Client Management, Operations) to achieve timely and high-quality service outcomes. • Build trust and rapport with members through clear communication, transparency, and follow-up. • Maintain accurate records of member interactions, resolutions, and follow-ups within the member services system. • Participate in team huddles, performance reviews, and training sessions to support continuous improvement. • Perform additional duties as assigned in support of departmental and organizational goals. Qualifications • Bachelor’s degree (preferred) • Minimum 2 years of experience in a PBM, health plan, or medication therapy management (MTM) call center; or 4 years of experience in a hospital or retail pharmacy setting. • At least 2 years of experience in a customer service-related field, preferably within healthcare or pharmacy. • Prior experience with benefit investigations, prior authorizations, or claims processing preferred. • Active Pharmacy Technician Certification (CPhT) required. Requirements • Strong customer service orientation with a commitment to concierge-level support. • Excellent verbal and written communication skills with active listening and empathy. • Proficiency in Microsoft Office Suite and related systems (CRM, ticketing, or case management tools). • Ability to think critically, problem-solve, and make sound decisions under pressure. • Exceptional time management and organizational skills; able to manage multiple priorities in a fast-paced environment. • Collaborative mindset with the ability to work cross-functionally to ensure resolution and client satisfaction. Benefits • Paid Time Off • 401(k) program • Health Insurance including Dental & Vision coverage • Health Savings Account • Employee Assistance Program Apply tot his job Apply To this Job