Pharmacy Customer Service Representative

Overview

Molina Healthcare is seeking multiple Pharmacy Customer Service Representatives for a remote call center team that supports pharmacy prior authorization and utilization management activity. The role focuses on helping Medicaid and Marketplace members, along with providers and pharmacies, with pharmacy-related service needs. Applicants in later U.S. time zones are especially encouraged.

This is a pharmacy contact-center position centered on resolving issues during the first interaction and delivering a strong member experience.

Work schedule

The standard schedule is Monday through Friday, from 10:00 AM to 6:30 PM PST, though hours may change based on business requirements.

Key responsibilities

• Answer and place pharmacy-related calls for members, providers, and pharmacies while supporting overall medication access and quality outcomes.
• Document inbound and outbound calls in line with company procedures, state rules, NCQA expectations, and CMS requirements.
• Process prior authorization requests and appeal-related work.
• Explain pharmacy claim decisions at the point of sale and clarify relevant policies, including formulary details, copay information, pharmacy location support, and prior authorization results.
• Handle clerical tasks and other routine pharmacy call center duties as assigned.
• Help members and providers start verbal or written coverage determination and appeal requests.
• Enter call details accurately into the pharmacy tracking system.
• Work to meet set standards for call quality and productivity.
• Coordinate with primary care providers to keep member registry information accurate and up to date.
• Support pharmacists with comprehensive medication review preparation and related pre-work.
• Look for opportunities to improve the member experience within the pharmacy call center.

Required qualifications

• At least 1 year of relevant experience, which may include call center or customer service work, or a comparable mix of education and experience.
• Strong customer service capability.
• Ability to work on independent assignments such as pill box requests, case management referrals, and OTC requests.
• Comfort juggling multiple applications while speaking with members.
• Ability to build and maintain productive working relationships with coworkers, clients, members, providers, regulatory bodies, and vendors.
• Ability to meet deadlines and manage several priorities independently.
• Clear verbal and written communication skills, including professional phone etiquette.
• Working knowledge of Microsoft Office, including Excel, and other relevant software tools.

Preferred qualifications

• Certified Pharmacy Technician (CPhT) certification and/or a state pharmacy technician license, where required by the state. Any license must be active and unrestricted in the state of practice.
• Prior experience in the healthcare industry.

Compensation and additional information

The posted pay range is $11.09 to $24.02 per hour. Actual pay may differ depending on geographic location, prior work experience, education, and skill level.

Molina Healthcare states that it offers competitive benefits and a compensation package. The company is an Equal Opportunity Employer (EOE) M/F/D/V.

Current Molina employees who want to apply are instructed to use the internal job board.