Pharmacy Help Desk (PHD), Pharmacy Unit

State of Maine • Augusta, ME

1d • $19 - $27 • Hybrid

About The Position

If you are a current State of Maine employee, you must complete your application through the internal application process (Find Jobs Report). Please apply using your PRISM account. If you are on Seasonal Leave and do not have access to PRISM, contact your local Human Resources representative for application information. Department of Health and Human Services (DHHS) Medical Support Specialist Claims Opening Date: December 22, 2025 Closing Date: January 7, 2026 Job Class Code: 6574 Grade: 16 (Admin Svcs) Salary: $18.76 - $27.03 per hour Position Number: 02000-3161 Location: This is a full-time position located at 109 Capitol Street, Augusta, Maine. This opportunity allows partial telework with management approval. This position reports to the MaineCare Pharmacy Help Desk Supervisor. Core Responsibilities: • Responds to calls from MaineCare members, pharmacists, and technicians representing various coverage plans. • Research pharmacy claims and prior authorizations with a depth of knowledge of our Preferred Drug List (PDL). • Educates MaineCare members regarding various Medicare Part D Medicare Savings Program/Medicare buy-in plans including how to choose a plan and how the plan pays benefits. • Assist MaineCare members with enrollment process. • Reviews insurance coverage for pharmacies, doctor’s offices, hospitals, MaineCare members, and other identified individuals/organizations. • Evaluates claims processing. • Assist MaineCare members with problems related to co-pays, deductibles, premiums, or other related issues. • Assist MaineCare members who are out of medication or are unable to fill prescriptions. Minimum Qualifications: Training, education, or experience in office and administrative support work that demonstrates competency in applying a proficient knowledge of medical terminology and medical support functions to perform advanced work in adjusting medical claims errors for adjudication and 2) the ability to use independent judgment, initiative, and discretion to make determinations on varied matters. Preferred experience includes: • Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations • Training and/or experience analyzing, evaluating, and responding to MaineCare and/or Medicare Part D claims processing and practices • Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage The background of well-qualified candidates will demonstrate the following competencies: 1. Knowledge of healthcare benefit programs (e.g., MaineCare and Medicare) with special concentration in Medicare Part D (Prescription Drug Coverage). 2. Working experience in a call center with time-sensitive performance metrics. 3. Ability in providing kind, courteous, and exceptional customer service. Thinking about applying? Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you’re currently reading this and hesitating to apply for that reason, we encourage you to go for it! Let us know how your experience and passion set you apart. Agency information: The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers. The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program, which provides health insurance coverage for low-income families, adults and children so they can access the important health care services they need to be healthy and be a part of the community through work, caring for family, going to school, and more. OMS works collaboratively within DHHS, with other Departments and the Office of the Governor, with MaineCare members, with providers, and with other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and health outcomes for all low-income Mainers. OMS provides benefit coverage and supports the services that operate in alignment with Department goals, federal mandates and State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration. The PHD position is part of the Pharmacy Unit, within OMS. As the only member help desk staffed by MaineCare, the PHD serves a unique role in the office. This high-volume call center position provides time-sensitive telephone assistance to MaineCare members, internal teams, and external partners. Application Information: For questions about this position, please contact Sherry Baldwin at [phone] or by e-mail [email protected] To apply, upload a resume and cover letter addressing the three competency areas identified in the Minimum Qualifications Section. Please submit all documents or files in PDF or Word format. To request a paper application, please contact [email protected] Benefits of working for the State of Maine: No matter where you work across Maine state government, you find employees who embody our state motto—"Dirigo" or "I lead"—as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including: Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave. Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State. Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements. Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value). Retirement Plan – The State contributes the equivalent of 14.11% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS). Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including fathers and adoptive parents—receive six weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act. State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness. Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time. There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role. As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics. If you’re looking for a great next step, and want to feel good about what you do, we’d love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request. . If you are unable to complete the online application, please contact the Human Resources representative listed on the job opening you are interested in applying for. They will work with you for an alternative method of submitting. Join Maine State Government and Make a Difference in Your Community If you're looking for a fulfilling career that allows you to serve the public and make a difference, consider working with Maine State Government! Our departments boast an array of professions, including attorneys, biologists, correctional officers, equipment operators, engineers, human resources professionals, information technology experts, law enforcement officers, nurses, park rangers, social workers, and transportation workers. With more than 100 agencies, boards, and offices, Maine State Government is the perfect place to explore various industries and interests. Whether you're interested in finance or forestry, there's an opportunity for you to help make Maine an even better place to live. eases, there’s a place for you here, and your work will have meaning.

Requirements

• Training, education, or experience in office and administrative support work that demonstrates competency in applying a proficient knowledge of medical terminology and medical support functions to perform advanced work in adjusting medical claims errors for adjudication and 2) the ability to use independent judgment, initiative, and discretion to make determinations on varied matters.
• Knowledge of healthcare benefit programs (e.g., MaineCare and Medicare) with special concentration in Medicare Part D (Prescription Drug Coverage).
• Working experience in a call center with time-sensitive performance metrics.
• Ability in providing kind, courteous, and exceptional customer service.

Nice To Haves

• Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations
• Training and/or experience analyzing, evaluating, and responding to MaineCare and/or Medicare Part D claims processing and practices
• Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage

Responsibilities

• Responds to calls from MaineCare members, pharmacists, and technicians representing various coverage plans.
• Research pharmacy claims and prior authorizations with a depth of knowledge of our Preferred Drug List (PDL).
• Educates MaineCare members regarding various Medicare Part D Medicare Savings Program/Medicare buy-in plans including how to choose a plan and how the plan pays benefits.
• Assist MaineCare members with enrollment process.
• Reviews insurance coverage for pharmacies, doctor’s offices, hospitals, MaineCare members, and other identified individuals/organizations.
• Evaluates claims processing.
• Assist MaineCare members with problems related to co-pays, deductibles, premiums, or other related issues.
• Assist MaineCare members who are out of medication or are unable to fill prescriptions.

Benefits

• 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually
• Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary.
• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%.
• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value).
• Retirement Plan – The State contributes the equivalent of 14.11% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
• All employees who are welcoming a child—including fathers and adoptive parents—receive six weeks of fully paid parental leave.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 1-10 employees