Clinical Operations Specialist
On-siteOrlando, Florida, United States
Orlando, Florida, United StatesOn-siteFull TimeMedium
Full TimeMedium
Job Summary
Process claim overrides and prior authorizations while adhering to SOPs and 2-hour SLAs for escalation requests. Monitor case queues to ensure timely resolution and escalate complex issues to leadership. Collaborate with clinical pharmacists, call center reps, and internal stakeholders to streamline workflows and improve operational efficiency. Maintain white-glove service standards and precision in all communications and documentation. Manage multiple priorities in a fast-paced environment while supporting special projects as directed. Work fully on-site in Orlando, Florida, five days per week.
Required Qualifications
- High school diploma
- Certified Pharmacy Technician (CPhT)
- Minimum 5 years of pharmacy experience
- At least 2 years in claims adjudication
- At least 2 years in prior authorization processes
- Must be able to work on-site five days per week
- Monday – Friday | 10:30am-7pm EST
- Fully On-Site in Orlando Florida
- 5 Days per Week
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
- Exceptional attention to detail and organizational skills
- Strong customer service orientation and interpersonal skills
- Demonstrated ability to meet tight deadlines and manage multiple tasks efficiently
- Strong critical thinking and problem-solving capabilities
Desired Qualifications
- Bachelor's degree
- 2 years of experience in a PBM, health plan, or related healthcare environment
- Active Pharmacy Technician License
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