Certified Pharmacy Technician - Prior Authorizations, Appeals Department
Job Description
This role offers the opportunity to support patients by reviewing denied prior authorizations for Medicare and Medicaid prescriptions and coordinating with pharmacists to help reach fair and timely appeal decisions. You will work primarily with Medicare members, many of whom are older adults, to gather additional information, clarify details about their medications, and ensure that each case is accurately documented before it is sent for final clinical review. The position combines pharmacy knowledge, careful data entry, and compassionate phone-based customer service to help patients access the medications they need.
Responsibilities
+ Review denied prior authorization requests for Medicare and Medicaid prescriptions, with a primary focus on Medicare cases.
+ Evaluate the information provided in each appeal to determine what additional details are needed for a thorough review.
+ Make 30-60 outbound calls per shift to members, caregivers, providers, or other relevant contacts to obtain missing or clarifying information.
+ Communicate clearly and professionally with Medicare members, including elderly individuals who may be frustrated about medication denials, and help them understand the appeals process.
+ Gather, verify, and accurately enter case details and supporting information into the appropriate systems for each appeal.
+ Prepare complete and organized case files and route them to pharmacists for final determination on whether to uphold or overturn the denial.
+ Follow established managed care, claims, and appeals procedures and timelines to ensure compliance and efficiency.
+ Use effective call control techniques to guide conversations, de-escalate concerns, and redirect discussions when necessary while maintaining empathy and professionalism.
+ Collaborate with pharmacists and other team members to resolve issues, clarify questions, and support consistent decision-making.
+ Protect sensitive member information and adhere to all applicable privacy and confidentiality standards.
Essential Skills
+ Experience as a pharmacy technician or in a similar pharmacy-related role, with familiarity in handling prior authorizations and medication-related documentation.
+ Strong data entry skills with a high level of accuracy and attention to detail.
+ Knowledge of appeals, denials, claims, and managed care processes in a pharmacy or healthcare setting.
+ Demonstrated customer service experience over the phone, including the ability to handle challenging or emotional conversations.
+ Ability to control and guide conversations, de-escalate frustration, and redirect discussions as needed while remaining calm and professional.
+ Clear and empathetic verbal communication skills, especially when speaking with elderly or vulnerable populations.
+ Ability to review, interpret, and organize clinical and administrative information for pharmacist review.
+ Proficiency in using computer systems and software for documentation, case tracking, and data entry.
Additional Skills & Qualifications
+ Prior experience working with Medicare and Medicaid members or within a managed care environment.
+ Background in pharmacy appeals, prior authorizations, or similar utilization management functions.
+ Familiarity with injectable medications and treatments commonly administered in a physician's office.
+ Strong problem-solving skills and the ability to think critically when gathering and clarifying information.
+ Ability to work efficiently in a structured, process-driven environment with defined performance expectations.
+ Comfort working in a role that is primarily phone-based with a focus on outbound calling.
Work Environment
This position operates in a professional, office-style or remote call center environment that is focused on supporting patients through the pharmacy appeals process. You will spend most of your time working on a computer and handling outbound phone calls to members and other stakeholders. The work follows structured procedures and established workflows for managing appeals, denials, and claims, and requires consistent attention to detail and accuracy. The role typically follows standard shift hours with defined call and documentation expectations throughout each shift. The environment emphasizes professionalism, clear communication, and respect for patient confidentiality while supporting a collaborative relationship with pharmacists and other team members.
Job Type & Location
This is a Contract to Hire position based out of Seattle, WA.
Pay and Benefits
The pay range for this position is $18.00 - $20.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on May 13, 2026.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I is embedded into our culture through:
+ Hiring diverse talent
+ Maintaining an inclusive environment through persistent self-reflection
+ Building a culture of care, engagement, and recognition with clear outcomes
+ Ensuring growth opportunities for our people
Actalent is an equal opportunity employer.
About Actalent
Actalent is a global leader in engineering and sciences services. For more than 40 years, we've helped visionary companies advance their goals. Headquartered in the United States, our teams span 150 offices across North America, EMEA, and APAC-with four delivery centers in India led by 1,000+ extraordinary employees who connect their passion with purpose every day.
Our Bangalore, Hyderabad, Pune, and Chennai delivery centers are hubs of engineering expertise, with core capabilities in mechanical and electrical engineering, systems and software, and manufacturing engineering. Our teams deliver work across multiple industries including transportation, consumer and industrial products, and life sciences. We serve more than 4,500 clients, including many Fortune 500 brands. Learn more about how we can work together at actalentservices.com.