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Pharmacy Resolution Specialist Jobs (NOW HIRING)

giftHEALTH Inc

Resolution Specialist

Columbus, OH · On-site

$22 - $28/hr

Work location: 4343 Equity Drive, Columbus, OH Position Summary As the Resolution Specialist at ... Knowledge of pharmacy operations and healthcare regulations is a plus. Success Metrics: * Reduction ...

Gifthealth Inc

Resolution Specialist

Columbus, OH · On-site

$22 - $28/hr

Work location: 4343 Equity Drive, Columbus, OH Position Summary As the Resolution Specialist at ... Knowledge of pharmacy operations and healthcare regulations is a plus. Success Metrics: * Reduction ...

Gifthealth

Resolution Specialist

Columbus, OH · On-site

$22 - $28/hr

Work location: 4343 Equity Drive, Columbus, OH Position Summary As the Resolution Specialist at ... Knowledge of pharmacy operations and healthcare regulations is a plus. Success Metrics: * Reduction ...

Curant Health

Pharmacy Supervisor

Smyrna, GA

$64.75 - $76.25/hr

Operates as a resolution specialist for all unusual issues with the Pharmacy Department and Shipping departments. * Active as a leader in the company, and an advocate for the department as a whole.

Curant Health

Pharmacy Supervisor

Smyrna, GA · On-site

$64.75 - $76.25/hr

Operates as a resolution specialist for all unusual issues with the Pharmacy Department and Shipping departments. * Active as a leader in the company, and an advocate for the department as a whole.

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How much do pharmacy resolution specialist jobs pay per hour?

As of Jul 29, 2026, the average hourly pay for pharmacy resolution specialist in the United States is $28.72, according to ZipRecruiter salary data. Most workers in this role earn between $18.99 and $36.06 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Pharmacy Resolution Specialist position, and why are they important?

To thrive as a Pharmacy Resolution Specialist, you need a solid understanding of pharmacy operations, claims processing, and healthcare terminology, often supported by relevant experience or a pharmacy technician certification. Familiarity with pharmacy management software, insurance claim systems, and HIPAA compliance is typically required. Strong analytical skills, effective communication, and attention to detail are valuable soft skills for resolving complex issues efficiently. These abilities help ensure timely and accurate resolution of pharmacy-related concerns, directly impacting patient satisfaction and healthcare service quality.

What is a Pharmacy Resolution Specialist job?

A Pharmacy Resolution Specialist is responsible for resolving issues related to pharmacy claims, insurance coverage, and medication approvals. They work with healthcare providers, insurance companies, and patients to ensure prescriptions are processed correctly and efficiently. Their duties may include investigating claim denials, communicating coverage options, and troubleshooting billing discrepancies. Strong problem-solving skills and attention to detail are essential for this role.

What are the typical challenges faced by Pharmacy Resolution Specialists in their daily work?

Pharmacy Resolution Specialists often encounter challenges such as navigating complex insurance claims, coordinating with multiple stakeholders (patients, pharmacists, insurers), and investigating discrepancies in medication authorizations. Balancing high call or case volumes while ensuring accuracy and compliance with healthcare regulations is another common aspect of the role. Successful specialists view these challenges as opportunities to problem-solve, improve processes, and enhance the patient experience. Supportive teams and ongoing training are typically provided to help you manage these demands effectively.

More about Pharmacy Resolution Specialist jobs
What are the most commonly searched types of Pharmacy Resolution Specialist jobs? The most popular types of Pharmacy Resolution Specialist jobs are:
What job categories do people searching Pharmacy Resolution Specialist jobs look for? The top searched job categories for Pharmacy Resolution Specialist jobs are:
Pharmacy Resolution Specialist jobs near you
Infographic showing various Pharmacy Resolution Specialist job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 69% Full Time, 27% Part Time, and 3% Contract. Highlights an 97% Physical, and 3% Remote job distribution, with an average salary of $59,736 per year, or $28.7 per hour.

Pharmacy Quality & Resolution Specialist

VIVA Health

Birmingham, AL

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Viva Health rating

8.1

Company rating: 8.1 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

148th of 299 rated insurance

Job description

Pharmacy Quality & Resolution Specialist

Location: Birmingham, Alabama

Job Summary

The Pharmacy Quality & Resolution Specialist is responsible for ensuring the accuracy and efficiency of day-to-day operations of VIVA HEALTH’S pharmacy programs for all lines of business. This individual is responsible for coordinating with the contracted Pharmacy Benefit Manager (PBM) or vendor, assisting local pharmacies, assisting with regulatory agency requirements, ensuring utilization and eligibility issues are monitored and addressed, and handling escalated billing and claims inquiries related to drug coverage and benefits.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

  • Comprehensive Health, Vision, and Dental Coverage
  • 401(k) Savings Plan with company match and immediate vesting
  • Paid Time Off (PTO)
  • 9 Paid Holidays annually plus a Floating Holiday to use as you choose
  • Tuition Assistance
  • Flexible Spending Accounts
  • Healthcare Reimbursement Account
  • Paid Parental Leave
  • Community Service Time Off
  • Life Insurance and Disability Coverage
  • Employee Wellness Program
  • Training and Development Programs to develop new skills and reach career goals
  • Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Key Responsibilities

  • Provide Pharmacy department support of both external customers and our internal stakeholders by acting as a subject matter expert for complex and escalated drug coverage and benefit related issues. This includes direct outreach to internal departments and external customers such as members, pharmacies, provider offices, and decision-makers at employer groups to ensure smooth operations of pharmacy programs.
  • Thoroughly research issues and take appropriate action to resolve cases in a timely manner according to the quality standard. Resolve issues and communicate outcomes in a clear and concise manner by outreach to members, providers, or impacted internal, and external customers.
  • Assist the Medication Quality Team by scheduling Comprehensive Medications Reviews (CMR), work to proactively renew expiring prior authorizations (PAs), making member outreach calls to help educate members and improve member medication adherence and other related activities.
  • Assist with program and benefit change implementations for Medicare and Commercial business and assist with quality assurance reviews of such changes and programs.
  • Monitor, review, and analyze daily reject reports from the plan’s PBM according to Centers for Medicare and Medicaid Services (CMS) guidelines.
  • Analyze and follow up on identified issues to ensure the appropriate processing of Part B vs. D drugs and maintain the internal and external Hospice and End-Stage Renal Disease (ERSD) reports according to CMS guidelines.
  • Audit plan benefits, formulary updates, and any changes that the PBM implements.

REQUIRED QUALIFICATIONS:

  • High School Diploma or GED
  • At least 3 years of experience with HMO/PPO/Medicare, pharmacy benefits management, retail pharmacy, long term care pharmacy, or hospital pharmacy
  • Current Pharmacy Technician License in good standing with the Alabama State Board of Pharmacy
  • CPhT (Certified Pharmacy Technician) from the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association
  • Demonstrate excellent customer service skills through written and verbal communication
  • Proficient in the Microsoft Office suite of products including Word, Excel, Access, and PowerPoint

PREFERRED QUALIFICATIONS:

  • At least two years of college

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