Original listing text, shown exactly as published by the company.
Position Responsibilities
- Act as the primary point of contact for incoming member calls, prior authorization inquiries, and ensure appropriate escalation of cases and all intake notes to the Clinical Prior Authorization Team
- Actively intake a thorough and complete prior authorization request from prescribers and members by asking applicable drug and client-specific clinical questions
- Accurately advise callers on options for exception requests (formulary, copay, early refill, etc.) based on client benefit elections and provide additional information and status updates to prescribers, members, and pharmacies
- Efficiently triage incoming calls with professional phone etiquette from members, prescribers, and pharmacies with minimal support. Ask probing questions to identify and resolve all issues and address concerns promptly
- Act as a valuable resource for Customer Service Representatives supporting member and pharmacy inquiries, stepping in as needed based on demand. Proactively identify, document, and address member and pharmacy concerns to ensure everyone receives the care and attention they deserve
- Effectively communicate issues and solutions to members, pharmacies, and relevant internal stakeholders to ensure customers receive quality care and that the resolution meets all health and safety standards
- Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast-paced environment
- Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
- Assist with onboarding and training of new team members or temporary staff as needed
- Support the Fraud, Waste, and Abuse program by reviewing pharmacy claims information and communicating findings to appropriate internal staff
- Collaborate across different systems while utilizing up to two monitors, efficiently multitasking in a dynamic and fast-paced environment
- Self-starter who displays a positive attitude, strong work ethic, and excellent attendance
- Meet all departmental goals including schedule adherence, attendance, and quality monitoring
- Standard hours for training: Monday thru Friday, 9:00 am – 5:30 pm, Eastern
- Perform other customer support duties as assigned
- Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance
Required Qualifications
- High school diploma or the equivalent; associate or bachelor’s degree preferred
- A current National Certification as a Pharmacy Technician (CPhT) and a valid license are required
- 2+ years of pharmacy technician experience in a clinical pharmacy setting PBM, Health Plan, or related Health Care experience required
- 2+ years of customer service experience with a passion for building customer loyalty through exceptional listening, relationship building, and strong written and verbal communication
- Experience handling prior authorization requests/understanding of prior authorization requirements preferred
- Ability to work independently with minimal supervision, stay productive in a remote, high-volume, fast-paced, metric-driven call center environment
- Tech-savvy with proficiency in CRM systems, call center platforms, and Microsoft Office Suite.
- Demonstrated ability to meet performance metrics including call quality, resolution time, and customer satisfaction
- Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location.1 Gig plan required. Dial-up, satellite, WIFI, 5G or Cellular connections are NOT acceptable.
Preferred Attributes
- Bilingual Spanish highly preferred
- Medicare experience preferred
- Passion for healthcare and improving patient outcomes.
- Adaptability in a startup or high-growth environment.
- Experience supporting pharmacy operations or benefits administration.
- Commitment to diversity, equity, and inclusion.
This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.
Remote, US Salary Range$28—$28 USDAll employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.
