Company : Highmark Inc.Job Description : JOB SUMMARY This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations. ESSENTIAL RESPONSIBILITIES - Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. - Conduct research beyond medical policy review to make decisions on medication coverage requests. - Other duties as assigned. EDUCATION Required - Bachelor's degree in Pharmacy Substitutions - None Preferred - Doctorate degree in Pharmacy EXPERIENCE Required - 1 - 3 years in Pharmacy Preferred - None LICENSES OR CERTIFICATIONS Required - Registered Pharmacist Preferred - None SKILLS - Oral & Written Communication Skills - General Computer Skills - Problem Solving & Decision Making - Compliance - Prioritizing Language Requirement (other than English) None Travel Required None PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $67,500.00 Pay Range Maximum: $126,000.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

• Responsible for performing precertification and prior approvals • Tasks are performed within the RN scope of practice, under the Medical Director's direction, using independent nursing judgement • Determines medical necessity and appropriateness of services using clinical review criteria • Accurately documents all review rationales and determinations • Collaborates with physicians and other providers to facilitate the provision of services throughout the health care continuum • Performs accurate data entry • Participates in continuing education initiatives

Role Description Seeking Dental Hygienist to review claims with the submitted diagnostic material to make proper benefit determinations based on group contracts and DeltaUSA and departmental established guidelines/policies. Responsible for clearing up queues on a daily basis and to pend appropriate claims for additional information. Refers claims to dental consultants for review. Location: Candidates located more than 1 hour outside of our corporate office in Roanoke, VA and residing in the following states may be considered for remote work: FL, GA, ID, MD, NC, NE, SC, TN, VA, WI, WV. Essential Functions - Reviews diagnostic material (i.e. x-rays, periodontal charting, etc.) to determine appropriate benefits. - Adjudicate claim benefit review requests in a timely manner. - Refers claims to dental consultant for review when diagnostic materials do not appear to support the procedure requested. - Follows DeltaUSA guidelines and departmental guidelines/policies for claims processing. - Works in team concept with the CCU and other departments within Delta Dental. - Maintain accuracy and production numbers to meet department expectations. - Audited to ensure KPI’s are met monthly. Qualifications - Dental Assistant or Dental office manager. - Knowledge interpreting dental x-rays. - The ability to follow established procedures with moderate decision-making. - Extensive computer knowledge/skills. - Strong interpersonal and communication skills. - The ability to focus for long periods of time. - A positive attitude with ability to adapt to change and learn new things. Physical Demands and Work Environment The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: - While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. - Use of hands is required for such technological devices such as a computer, telephone and others. - The employee must occasionally lift and/or move up to 15 pounds. - Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. - The employee will be required to travel (sometimes long distances) to attend required meetings. Work environment: - The work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving. - The noise level in the work environment is usually minimal.

Neuroscience Health and Science Professional (HSP) - Peekskill, NY ROLE SUMMARY Everything we do, every day, is in line with an unwavering commitment to the quality and the delivery of safe and effective products to patients. Our science and risk-based compliant quality culture is innovative and customer oriented. Whether you are involved in manufacturing, testing, or compliance, your contribution will directly impact patients. All over the world, Pfizer colleagues work together to positively impact health for everyone, everywhere. Our colleagues can grow and develop a career that offers both individual and company success; be part of an ownership culture that values diversity and where all colleagues are energized and engaged; and can impact the health and lives of millions of people. Pfizer, a global leader in the biopharmaceutical industry, is continuously seeking top talent who are inspired by our purpose to innovate to bring therapies to patients that significantly improve their lives. Pfizer is advancing in Neuroscience, and an integral part of the Migraine Team’s mission is to promote a breakthrough therapy for patients suffering from migraine. The Neuroscience Health & Science Professional (HSP) is responsible for increasing territory sales and relationship development with assigned customers and accounts by engaging in product promotion and determining the best strategies to manage their business. The HSP should possess customer, market, and business acumen, analytical skills, and strong product and disease state knowledge; demonstrate ability to drive sales, promotional and strategic business development and management skills, and in-depth customer engagement expertise both in-person and virtually; demonstrate outstanding communication and teamwork skills; be adept in the operation of digital and virtual tools; and be effective at working remotely in collaboration with cross-functional internal teams to address customer needs and compliantly deliver on Pfizer business objectives. ROLE RESPONSIBILITIES · Drives sales in assigned territory. · Engages with customers both face to face and virtually. · Develops and implements effective business and territory call plans; effectively identifies and implements live/virtual engagement strategies with customer to maximize overall effectiveness and impact. · Effectively builds rapport and relationships with customers in both live and virtual environments; uses judgment to maintain customer engagement by successfully utilizing existing and ever-changing digital tools effectively for successful customer engagement. · Understands and leverages internal reports and analytics to assist with identifying, developing, and implementing strategic business opportunities. · Compliantly leverages product and disease state knowledge to appropriately educate providers on unbranded and branded product value proposition for relevant patient populations and effectively and strategically utilizes approved clinically oriented disease state information and patient resources, as applicable. · Demonstrates strong teamwork capabilities to collaborate effectively and compliantly across the organization to address customer inquiries and advance Pfizer objectives. · Completes all administrative expectations on time and compliantly. BASIC QUALIFICATIONS · Bachelor’s Degree. · Minimum 2 years of experience in one or more of the following: - Professional Sales or Promotional Activity. - Small Business Owner or other Entrepreneurial experience, Marketing, Customer Service and/or Account Management. - Relevant Healthcare/Scientific roles (e.g., RN, Pharmacist, PT, OT, etc.). - Educator (e.g., Teacher, Principal). - Full Time Military experience. - Must live within 25 miles of the border of the territory. - Valid US driver’s license and driving record in compliance with company standards. Any DUI/DWI or other impaired driving citation within the past 7 years will disqualify you from being hired. PREFERRED QUALIFICATIONS · At least 1 year of pharmaceutical, biotech, medical sales and/or medical related marketing. · Strong track record of sales or marketing success, strong territory management skills, outstanding communications skills, as well as demonstrated teamwork, leadership ability and accountability. · Experience with applicable disease states, therapeutic area, and products. · Knowledge of posted territory customers and markets (prescribers/HCPs/institutions/organizations). · Reside within the territory boundaries. OTHER JOB DETAILS - Last Date to Apply: March 20, 2026. - Geography includes: Peekskill, NY and ​Southwestern CT. - Work Location Assignment: Remote - Field Based. The annual base salary for this position ranges from $76,000 - $199,600. During initial new hire sales training, you will be classified as a salary non-exempt employee which entitles you to overtime pay. Upon your training certification, you will become an overtime exempt employee. In addition, this position offers an additional quarterly Sales Incentive bonus. We offer comprehensive and generous benefits and programs to help our colleagues lead healthy lives and to support each of life’s moments. Benefits offered include a 401(k) plan with Pfizer Matching Contributions and an additional Pfizer Retirement Savings Contribution, paid vacation, holiday and personal days, paid caregiver/parental and medical leave, and health benefits to include medical, prescription drug, dental and vision coverage. Learn more at Pfizer Candidate Site – U.S. Benefits| (uscandidates.mypfizerbenefits.com). Pfizer compensation structures and benefit packages are aligned based on the location of hire. The United States salary range provided does not apply to any location outside of the United States. Relocation assistance may be available based on business needs and/or eligibility. Candidates must be authorized to be employed in the U.S. by any employer. U.S. work visa sponsorship (such as TN, O-1, H-1B, etc.) is not available for this role now or in the future. Sunshine Act Pfizer reports payments and other transfers of value to health care providers as required by federal and state transparency laws and implementing regulations. These laws and regulations require Pfizer to provide government agencies with information such as a health care provider’s name, address and the type of payments or other value received, generally for public disclosure. Subject to further legal review and statutory or regulatory clarification, which Pfizer intends to pursue, reimbursement of recruiting expenses for licensed physicians may constitute a reportable transfer of value under the federal transparency law commonly known as the Sunshine Act. Therefore, if you are a licensed physician who incurs recruiting expenses as a result of interviewing with Pfizer that we pay or reimburse, your name, address and the amount of payments made currently will be reported to the government. If you have questions regarding this matter, please do not hesitate to contact your Talent Acquisition representative. EEO & Employment Eligibility Pfizer is committed to equal opportunity in the terms and conditions of employment for all employees and job applicants without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, national origin, disability or veteran status. Pfizer also complies with all applicable national, state and local laws governing nondiscrimination in employment as well as work authorization and employment eligibility verification requirements of the Immigration and Nationality Act and IRCA. Pfizer is an E-Verify employer. This position requires permanent work authorization in the United States. Pfizer endeavors to make www.pfizer.com/careers accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process and/or interviewing, please email disabilityrecruitment@pfizer.com. This is to be used solely for accommodation requests with respect to the accessibility of our website, online application process and/or interviewing. Requests for any other reason will not be returned. Sales