Care & Resolution Specialist

Care & Resolution Specialist (REMOTE)

EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results. 

We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically™, EmpiRx Health’s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years.

Position Summary:

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.

What You’ll Do: 

Key Responsibilities:

Delivery & Case Management

• 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 issuer solution.
• 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.

Specialized Expertise

• 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.

Relationship Management & Collaboration

• 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.

 Education and Experience:

What You Need:

Education

• Bachelor’s degree preferred.

Experience

• 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.

Licensure/Certifications

• Active Pharmacy Technician Certification (CPhT) required.

Skills & Competencies

• 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 And Perks

Subject to program eligibility, this position qualifies for a robust suite of benefits including: Paid Time Off, a 401(k) program, Health Insurance including Dental & Vision coverage, Health Savings Account, and an Employee Assistance Program.

EmpiRx Health is an Equal Opportunity Employer 

At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're on a mission to build a team as diverse as the world we serve, where everyone is welcome and celebrated. We're not just breaking down barriers; we're actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together.

Note: This job description is a general outline of responsibilities and qualifications for the role. Additional duties may be assigned, and the position may evolve to meet the organization's needs.