Care & Resolution Specialist

Position Summary:

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.

Key Responsibilities:

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 toestablisheddaily processes, protocols, and escalation pathways.
• Serve as an administrative liaison between members, internal departments, and external partners (e.g., pharmacies, prescribers) tofacilitateaccurateandtimelyissueresolution.
• Manage and resolve cases related to prescription claims, authorizations, and other pharmacy benefit concerns, documenting outcomesin accordance withdepartmental 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 toidentifyroot causes of member issues and recommend process improvements.
• Stay current on EmpiRx Health program updates, products, and processes to ensureaccurateand compliant communication with members.

Relationship Management & Collaboration

• Foster collaboration with internal EmpiRx Health departments (e.g., Clinical, Client Management, Operations) to achievetimelyand high-quality service outcomes.

• Build trust and rapport with members through clear communication, transparency, and follow-up.
• Maintainaccuraterecords 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.
• Performadditionalduties as assigned in support of departmental and organizational goals.

Education & Experience

Education

• Bachelor’s degree preferred.

Experience

• 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.

Licensure/Certifications

• Active Pharmacy Technician Certification (CPhT)required.

Skills & Competencies

• Strong customer service orientation with a commitment to concierge-level support.
• Excellent verbal and written communication skills with active listening and empathy.
• Proficiencyin 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.

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