Licensed Pharm Tech - Claims & Prior Authorization

Licensed Pharm Tech - Claims & Prior Authorization

Location Fresno, CA | Onsite

COMPENSATION & SCHEDULE

• $22 per hour

• Full-time

• W2 employment | Temporary (possible conversion)

• Monday – Friday | 8 hour shift between 6:00AM – 7:00PM PST

• Rotating weekend coverage required

ROLE IMPACT

The Licensed Pharm Tech – Claims & Prior Authorization person plays a vital role in ensuring timely medication access by resolving pharmacy claims, benefit verification, and prior authorization inquiries. This position supports pharmacies, providers, and patients by delivering accurate information, compliant documentation, and efficient issue resolution. Success is measured by claims accuracy, service quality, documentation standards, and strict adherence to HIPAA and healthcare compliance regulations.

Key Responsibilities

• Serve as a licensed pharmacy technician resource handling inbound inquiries regarding pharmacy claims processing, benefit verification, eligibility, and prior authorizations

• Research and resolve claim rejections, third-party billing issues, and coverage discrepancies to prevent therapy delays

• Explain pharmacy benefit coverage, formulary requirements, and plan details clearly and professionally

• Accurately document case activity within the ticketing or case management system in accordance with compliance standards

• Escalate complex clinical or operational matters to pharmacists or internal support teams as appropriate

• Support omni-channel communication including phone, email, and chat

Minimum Qualifications

• Active Pharmacy Technician license in good standing (any state accepted)

• 2+ years of experience in pharmacy operations, pharmacy benefit management (PBM), healthcare operations, or high-volume customer support

• High school diploma or GED

Equipment & Work Environment

• Prolonged computer use with frequent operation of keyboard, mouse, multi-line phone system, and standard office equipment

• Primarily sedentary role with occasional standing, walking, bending, and reaching

• Fast-paced healthcare support environment with productivity and accuracy standards

Preferred Skills

• Experience in PBM, managed care, specialty pharmacy, or healthcare call center environments

• Familiarity with pharmacy claims adjudication systems and third-party billing processes

• Strong documentation accuracy and compliance-focused mindset

Legal Notice

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