Pharmacy Technician

The Pharmacy Technician supports multiple pharmacy operations areas, including formulary management, pharmacy audit and recovery, pharmacy service center, Medicare Part D and Part B, appeals, state health programs pharmacy operations, prior authorization, and Medicare Part D operations. Using established guidelines, this role reviews and processes requests from physicians, medical groups, pharmacies, and members for prescription drugs and pharmacy benefits, researches and resolves issues, and collaborates with clinical pharmacists and other healthcare professionals to ensure accurate, compliant, and timely pharmacy services.

Responsibilities

• Review and process formulary change requests from health plans and submit and maintain approved changes with the pharmacy claims processor.
• Generate, maintain, and review formulary status grids, using reports to perform audits and quality checks to ensure accuracy and contract compliance.
• Assist clinical pharmacists with formulary database maintenance and updates to internal systems and websites.
• Perform a variety of pharmacy audit and recovery assignments, including reviewing paid claims for quantity and billing discrepancies.
• Correspond with pharmacies to communicate audit findings, fax inquiries related to review results, and respond to incoming calls and faxed correspondence from pharmacies.
• Update databases, including Access-based tools, with information from incoming phone calls, faxes, and emails.
• Handle member inquiry calls regarding pharmacy benefits, including prior authorization questions, and maintain expert knowledge of Medicare pharmacy benefits, formularies, and applicable regulations.
• Educate members on their specific pharmacy benefits and available options, including the submission of prior authorization requests, and process member-submitted claims.
• Review requests from physicians and pharmacies for non-formulary drugs, drugs requiring prior authorization, drugs exceeding quantity or cost limits, or claims requiring assistance with online processing.
• Assign, enter, and document prior authorizations into the appropriate claims processing systems and answer phone calls related to prior authorization inquiries.
• Research and resolve issues using appropriate reference materials and maintain a thorough understanding of pharmacy and medical benefits.
• Review and process Medicare Part D event (PDE) files, research and resolve related issues, and assist with pharmacy claims correction projects.
• Perform audits and quality checks on active prior authorization claims and assist with identifying and correcting eligibility and group issues.
• Serve as a liaison to internal and external departments for state health programs pharmacy operations and support operational issue resolution, including issues related to prior authorization, appeals and grievances, and member or provider services.
• Prepare and review operational reports and audits for state health programs and perform formulary management functions, including quarterly formulary updates to websites, databases, and benefit maintenance.
• Maintain prior authorization database files, process Medi-Cal direct member reimbursement (DMR) requests, and assist with state health program clinical projects and Medi-Cal prior authorizations.
• Assist in the implementation of regulatory changes and participate in maintaining consistent processes and methods for developing, implementing, communicating, and training on new or updated policies and procedures.
• Collaborate with business units and departments to ensure end-to-end process connectivity and effective handoffs in procedures that span multiple departments.
• Provide support and monitoring to help ensure compliance of first tier, downstream, and related entities and assist with department preparation for internal and external audits, including building case files, universes, and evidence of compliance.
• Identify the validity of appeals and route non-valid appeals to the appropriate department for handling.
• Verify drug, dosage, quantity, provider, and diagnosis information for appeals and research formularies and prior authorization criteria to determine whether additional information is required.
• Contact providers and members to obtain additional information for appeals and clearly communicate what information is needed, performing other appeal-related tasks as assigned.
• Track and triage Medicare Part D and Part B coverage determination and prior authorization requests from providers and determine when pharmacist review is required.
• Obtain verbal authorizations and request detailed clinical information from prescribers, approving coverage determinations and prior authorization requests based on defined criteria when appropriate.
• Enter and document coverage determination and prior authorization decisions in the pharmacy benefit management (PBM) system and notify providers and members of outcomes.
• Respond to client inquiries regarding authorization approvals and PBM online activity, refer specialty drug coverage determinations to delegated vendors or clients as required, and contact providers for additional information to facilitate coverage reviews.
• Notify physicians, providers, and members of coverage determination decisions and perform other duties as assigned while complying with all applicable policies and standards.

• High school diploma or GED.
• At least 1 year of experience as a Pharmacy Technician.
• Experience with pharmacy operations such as formulary management, prior authorization, appeals, or claims processing.
• Strong data entry skills with attention to accuracy and detail.
• Ability to review and process prescription drug and pharmacy benefit requests using established guidelines.
• Ability to research and resolve questions, problems, and issues related to pharmacy claims and benefits.
• Proficiency in handling phone inquiries from members, providers, and pharmacies in a professional and service-oriented manner.
• Ability to work with pharmacy claims processing systems and databases, including updating and maintaining records.
• Strong organizational skills to manage multiple tasks such as audits, reports, and prior authorizations simultaneously.
• Effective written and verbal communication skills for interacting with members, providers, internal teams, and external partners.

• Customer service or retail experience is preferred.
• Valid Pharmacy Technician license is preferred.
• Experience with prior authorization, appeals, and coverage determinations is beneficial.
• Familiarity with Medicare Part D and Part B pharmacy benefits and related regulations is an advantage.
• Experience with state health programs, including Medi-Cal, is helpful.
• Ability to use Access databases or similar tools for tracking calls, faxes, emails, and audit activities.
• Comfort working with formularies, benefit structures, and pharmacy benefit management systems.
• Experience supporting internal and external audits and regulatory compliance activities is a plus.

The role operates in a structured pharmacy operations environment that supports multiple functions, including formulary management, prior authorization, appeals, audit and recovery, and Medicare and state health program pharmacy operations. Work is primarily performed using computer-based systems, pharmacy benefit management platforms, claims processing tools, and databases such as Access. The position involves significant interaction via phone, email, and fax with members, providers, pharmacies, internal departments, and external partners. The schedule typically follows standard business hours, with expectations for timely response to inquiries, accurate documentation, and adherence to established policies, procedures, and regulatory requirements. The environment emphasizes compliance, quality, accuracy, and collaboration across teams to ensure consistent and reliable pharmacy services.

Job Type & Location

This is a Contract to Hire position based out of Stamford, CT.

The pay range for this position is $18.00 - $20.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on May 16, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.

Salary : $18 - $20