Serving as a pharmacy systems coding subject matter expert for Prior Authorization, the remote Senior Specialist, Pharmacy Systems Operations will manage medical drug claim processing, utilization management reviews, and appeals while providing technical support for system integrations and operations. Key responsibilities Collaborate in defining and reviewing business requirements for system updates and claims projects Perform solution analysis and provide direction to ensure compliance with business protocols and mandates Troubleshoot unpaid claims and act as a liaison for day-to-day medical drug system-related technical issues Required qualifications Bachelor's degree required 4 - 6+ years of relevant professional work experience 2+ years' experience in claims processing, pharmacy/coding, or utilization management Experience in a healthcare environment Proficiency with MS Office applications