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

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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

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