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

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.

What You’ll Do

• 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.

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