Job Description
**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan’s state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures.
**ESSENTIAL RESPONSIBILITIES**
+ Communicate effectively with physician and pharmacy network provider...
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan’s state and federal multiple drug benefit design offerings. The incumbent responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures.
**ESSENTIAL RESPONSIBILITIES**
+ Communicate effectively with physician and pharmacy network provider...
Ready to Apply?
Submit your application today and join our talented team at Highmark Health.
Submit ApplicationJob Details
- Location Trenton, NJ
- Job Type Full-time
- Category other-general
- Posted Date June 08, 2026
- Application Deadline June 13, 2026