Clinical Services Representative

Job Summary

To support a growing healthcare team, the full-time Clinical Services Representative will provide remote assistance for clinical inquiries, prescription benefits, and claims processing, ensuring effective communication with members, pharmacies, and healthcare providers.

Key responsibilities

• Answer and respond to inquiries from members, clients, pharmacies, and healthcare professionals via phone, email, and fax
• Research and troubleshoot prescription claims and claims-processing issues while maintaining accurate documentation
• Assist with prior authorization processes and communicate relevant information to management and internal teams

Required qualifications

• Two or more years of applicable healthcare, pharmacy, PBM, insurance, or customer service experience
• Experience with prescription claims processing or claims adjudication systems
• Strong analytical and problem-solving skills
• Ability to multitask and prioritize in a fast-paced contact center environment
• Dependability and reliable attendance with the ability to work independently as part of a remote team