St. Luke's Health System

Customer Care Pharmacy Specialist

St. Luke’s Health Plan
Boise, Idaho
Full-Time | Onsite 

Overview

St. Luke’s Health Plan is seeking a Customer Care Pharmacy Specialist to serve as the primary point of contact for members, prescribers, and pharmacies regarding pharmacy benefit inquiries and concerns. This role plays a critical part in delivering exceptional customer service while supporting accurate claims processing, prior authorizations, and benefit interpretation across all lines of business, including government-funded programs.

This position is full-time and onsite in Boise, Idaho.

What You’ll Do

• Serve as the first point of contact for member, prescriber, and pharmacy inquiries via phone, email, and secure messaging.
• Provide accurate, timely responses regarding pharmacy benefits, formulary coverage, claim status, and reimbursement questions.
• Review supporting clinical documentation submitted by prescribers and validate information against therapeutic indications and plan requirements.
• Process and support prior authorization requests under pharmacy benefits.
• Accurately document all member interactions in the CRM system to ensure compliance and continuity of service.
• Assist members with benefit and enrollment verification; explain plan design elements such as deductibles, copays, coinsurance, and formulary tiers.
• Resolve routine claims adjudication issues and escalate complex or clinically sensitive matters to Tier 2 or clinical teams as appropriate.
• Apply knowledge of high-cost specialty medications, pharmaceutical regulations, and cost-containment strategies.
• Maintain compliance with HIPAA, CMS guidelines, and St. Luke’s policies and procedures.
• Support continuous improvement initiatives and perform additional duties as assigned.

Minimum Qualifications

• High school diploma or GED
• Minimum of 1 year of related experience in healthcare, pharmacy, insurance, or customer service

Preferred Qualifications

• Experience in pharmacy benefit management (PBM), health plan operations, or managed care
• Familiarity with prior authorization workflows and claims adjudication processes
• Working knowledge of medical and pharmacy terminology
• Experience supporting Medicare, Medicaid, or other government-funded programs
• Strong understanding of specialty medications and formulary management

Skills & Competencies

• Exceptional customer service and communication skills
• Strong attention to detail and documentation accuracy
• Ability to interpret clinical documentation and pharmacy benefit information
• Critical thinking and problem-solving skills
• Ability to manage high-volume interactions in a structured, compliance-driven environment
• Proficiency in CRM systems and Microsoft Office applications

Working Conditions

• Primarily desk-based role
• Frequent communication with members and providers
• Frequent use of computer systems and phone systems
• Ability to remain in a stationary position for extended periods
• Occasional lifting of materials up to 25 lbs

At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.