Pharmacy Service Specialist

Workforce Classification:

Join Our Team: Do Meaningful Work and Improve People’s Lives 

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Inclusion, and America's Greatest Workplaces For Mental Well-Being, Forbes ranked Premera among America’s Best Midsize Employers for the fourth time.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:  https://healthsource.premera.com/.

As a Pharmacy Services Specialist, you will play a pivotal role in supporting Pharmacy Service Operations and Pharmacy Programs, ensuring both provider and customer satisfaction. Your responsibilities will include completing prior authorization review requests from providers, performing level I reviews for Prior Authorization exception requests according to clinical criteria, and collecting relevant medical and prescription information to support the review of non-formulary exception requests and prior authorization requests. 

Schedule:

Core service hours: Monday through Friday 7:30 AM to 5:00 PM.  Regular Saturday and Sunday rotation required; estimated weekend coverage every 4 to 6 weeks.  Holiday coverage rotation required.  Core service hours subject to change based on business needs.

What you’ll do:

Support the Pharmacy Prior Authorization Program by:

• Performing level I review for Prior Authorization exception requests according to clinical criteria.
• Collecting relevant medical and prescription information to support the review of non-formulary exception requests and prior authorization requests.
• Setting up authorizations and initiating appropriate paperwork and notification process.
• Documenting exception requests status and outcomes in all relevant systems.
• Determining customer eligibility, verifying and interpreting pharmacy benefits as required.
• Requesting and reviewing necessary medical records for level II reviews, sending requests with documentation and recommendations to the Assistant Medical Directors for final review.
• Contribute to team efficiency by providing support to fellow team members.
• Maintain knowledge of Premera health plan policies and benefits, current treatment procedures and alternative resources.
• Serve as a resource for other departments for pharmacy program questions.
• Other duties as assigned.

What you’ll bring:

• Current and valid State Pharmacy Technician License (Required).
• Three (3) years' experience as a Pharmacy Technician (Required).
• Experience in customer service with both internal and external customers.
• Completion of pharmacy technician training from an accredited Pharmacy Technician program.
• Prior health insurance experience preferred.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.

• Voluntary benefit offerings, including pet insurance for paw parents.