Managed care environment jobs

Pharmacy Representative

Blue Cross Blue Shield of Massachusetts · Posted Nov 9, 2026

Hingham, Massachusetts, United States
Full-time
$22–$27 per hour

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The Pharmacy Operations Representative is responsible for primary contact for our providers to obtain authorization for retail pharmacy, home infusion and medical utilization management requests.

Compensation

Hourly Range: $22.43 - $27.42

Responsibilities

Receive, process, and archive provider’s retail fax and phone authorization requests accurately using multiple computer systems against our Medical Policy Criteria.
Review and interpret member’s eligibility, claim history, and Pharmacy Program information using the PBM claims software to provide information to both internal and external clients via telephone or email.
Analyze and interpret high level medical data and accurate data entry information according to NCQA guidelines.
Receive, process, and archive Home Infusion Therapy and Utilization Management Medical requests accurately using MHK and other systems via fax or telephone.
Communicate determinations to providers via incoming and outgoing telephone calls.

Requirements

High school diploma required
Associate or Bachelor’s degree preferred
Nice to have: Associate degree
Nice to have: Bachelor’s degree

Skills

MHK PBM system

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