Senior Pharm PA/Appeals Technician

UnitedHealth Group•Portland, ME

14d•$18 - $32•Remote

About The Position

The Senior Pharmacy PA/Appeals Technician supports prior authorization and appeals processes by providing accurate, timely, and professional service to members, providers, pharmacists, and internal business partners. The role receives, researches, documents, and processes prior authorization requests for formulary and non-formulary medications through phone, fax, and electronic systems. It reviews requests against established criteria, verifies member, provider, medication, diagnosis, benefit, and plan information, identifies missing information, and routes clinical questions or judgment-based decisions to a pharmacist or clinician. The position requires detailed documentation, compliance with regulatory and contractual requirements, and adherence to turnaround times and service-level agreements. This is a remote position for candidates located in Vermont or Maine. The schedule is an eight-hour shift Monday through Friday, scheduled between 8 a.m. and 8 p.m. Eastern Time, with rotating on-call weekend responsibilities on Saturdays or Sundays. The schedule may vary with business needs and may include overtime, evenings, and holidays. The role involves high-volume calls and case processing in a fast-paced, metric-driven environment. The technician supports patient safety and quality by following approved criteria, policies, procedures, and regulatory requirements; escalating safety, medication, benefit, system, privacy, or quality concerns; and incorporating feedback and updated workflows. Employees working remotely must comply with UnitedHealth Group’s Telecommuter Policy and maintain a secure, private workspace and reliable high-speed internet. The position offers an hourly pay range of $18.00 to $32.00, based on factors including local labor markets, education, work experience, and certifications. External applicants may be eligible for a $1,000 sign-on bonus.

Requirements

Active and unrestricted Pharmacy Technician licensure, registration, or certification as required by the state of residence and business needs; applicable requirements must be maintained throughout employment.
Pharmacy Technician Certification Board (PTCB) certification, state Board of Pharmacy licensure or registration where required, ExCPT certification through the National Healthcareer Association, or another approved prior authorization or pharmacy technician certification accepted by the business.
At least 6 months of experience in customer service, customer relations, healthcare, pharmacy, a call center, or direct interaction with healthcare professionals.
Basic proficiency with Microsoft Excel, Word, Outlook, and Teams, including creating, editing, saving, sending, and managing basic documents, spreadsheets, emails, and communications.
Basic ability to navigate multiple systems, screens, job aids, knowledge articles, and electronic workflows accurately during calls and case processing.
Ability to work an eight-hour shift Monday through Friday between 8 a.m. and 8 p.m. Eastern Time, with rotating on-call weekend responsibilities on Saturdays or Sundays, and possible overtime, evenings, and holidays as business needs require.
Must currently be located in Maine or Vermont.
Strong verbal and written communication skills to explain information clearly, professionally, and accurately to providers, members, pharmacists, and internal partners.
Strong attention to detail and ability to apply established criteria, workflows, and documentation standards consistently.
Ability to manage competing priorities, follow through on assigned tasks, and meet deadlines in a fast-paced, metric-driven environment.
Critical thinking, problem-solving, and sound judgment to identify incomplete information, workflow barriers, compliance concerns, and situations requiring escalation.
Ability to accept feedback, adjust performance, and support continuous improvement in quality, productivity, service, and compliance.
Frequent speaking and listening using a headset; sitting for extended periods; using hands and fingers across a keyboard and mouse; and working at a computer for extended periods.
Reliable high-speed home internet access, with the ability to use a hard-wired Ethernet connection when required.
Secure, private home workspace that supports protection of confidential information and compliance with telecommuting, privacy, and security policies.
Intermediate comfort using a computer, including keyboard and mouse navigation, opening applications, switching between multiple systems and screens, and learning new tools or workflows.
Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.
Candidates must pass a drug test before beginning employment.

Nice To Haves

Experience with prior authorization, appeals, pharmacy benefit management, prescription drug benefits, formulary review, pharmacy claims, or healthcare coverage processes.
Knowledge of Medicare Part D, commercial, Medicaid, exchange, or client-specific pharmacy benefit requirements.
Knowledge of call center systems such as CMS, IEX, CTI, TCS, or similar telephony, workforce, and case-management platforms.
Experience in a high-volume, production-based, quality-monitored, or compliance-driven environment.
Familiarity with pharmacy terminology, medication names, brand and generic drug names, SIG codes, benefit terminology, and healthcare documentation standards.

Responsibilities

Manage a high volume of inbound and outbound calls, averaging 50 or more daily, while meeting professionalism, accuracy, and customer service expectations.
Respond to prior authorization inquiries and requests from providers, pharmacies, members, and internal partners using approved scripts, reference materials, job aids, policies, and procedures.
Review and process prior authorization requests through multiple computer systems, ensuring information is complete, accurate, and documented according to applicable requirements.
Research formulary, benefit, medication, eligibility, and plan-specific information to resolve prior authorization questions, benefit issues, and case-processing barriers.
Gather and verify member, provider, prescriber, pharmacy, medication, diagnosis, and clinical support information needed for pharmacist consultation or clinical review.
Identify missing or incomplete information and follow up, including by outbound calls or routing the case to the appropriate team, pharmacist, or clinician.
Prioritize work to meet turnaround times for standard, expedited, urgent, and client-specific requests.
Maintain productivity, quality, schedule adherence, attendance, and documentation standards.
Resolve issues and complaints professionally and promptly, escalating concerns when clinical review, additional support, or leadership guidance is needed.
Apply established criteria and guidelines to support accurate and compliant case processing.
Document calls, case actions, approvals, denials, transfers, escalations, and follow-up activity in appropriate systems.
Protect confidential information and handle protected health information in accordance with privacy, security, HIPAA, regulatory, and company requirements.
Recognize when a request requires pharmacist review, clinical clarification, additional documentation, or leadership escalation.
Adapt to changing workflows, client requirements, system updates, job aids, and business priorities while maintaining accuracy and service standards.
Support patient safety and quality by following approved criteria, policies, procedures, and regulatory requirements; identify and escalate potential safety, medication, benefit, system, privacy, or quality concerns.
Maintain a safe and secure workspace and notify leadership if equipment, system access, information security, or workspace conditions may affect safe and compliant work.
Participate in quality improvement efforts by applying feedback, correcting errors, and following updated job aids, workflows, and standard operating procedures.
Perform other duties as assigned by management.

Benefits

Paid time off accrued beginning with the first pay period, plus 8 paid holidays.
Medical plan options and participation in a Health Spending Account or Health Savings Account.
Dental insurance.
Vision insurance.
Life and AD&D insurance.
Short-term disability coverage.
Long-term disability coverage.
401(k) savings plan.
Employee Stock Purchase Plan.
Education reimbursement.
Employee discounts.
Employee Assistance Program.
Employee Referral Bonus Program.
Voluntary benefits, including pet insurance, legal insurance, and long-term care insurance.
Performance rewards and incentive and recognition programs.
Comprehensive benefits package.
Potential $1,000 sign-on bonus for eligible external applicants.