Clinical Services Representative – Remote

Clinical Services Representative – Remote PharmaCentra LLC Employment Type: Full-Time Location: Fully Remote - United States Schedule: Monday–Friday, with hours scheduled through 10:00 PM ET; occasional weekend coverage may be required Hours: Up to 40 hours per week Make a Difference in Healthcare - From Home PharmaCentra LLC is a leading provider of customizable contact center solutions serving pharmaceutical companies, pharmacy benefit managers (PBMs), clinical research organizations, insurance providers, hospital groups, and other healthcare organizations. We are looking for a Clinical Services Representative to join our fully remote team. This position is an excellent opportunity for a healthcare professional who enjoys solving problems, working with healthcare information, and helping members, pharmacies, physicians, and clients resolve issues-without working in a traditional clinical setting. The Clinical Services Representative provides support for clinical inquiries, prescription benefits, pharmacy claims, prior authorization information, and claims-processing issues. You will work closely with members, pharmacies, healthcare providers, clients, and internal team members to research issues, communicate solutions, and ensure accurate documentation. If you have experience with pharmacy, PBM, prescription claims, prior authorizations, clinical customer service, or healthcare operations , we'd like to hear from you. What You'll Do Answer and respond to telephone calls, emails, and faxes from members, clients, pharmacies, physicians, and other healthcare professionals. Provide support for clinical and prescription-benefit inquiries. Assist Member Care Representatives with clinical questions and escalated member interactions. Research and troubleshoot prescription claims and claims-processing issues. Review information within claims adjudication and other applicable systems. Assist with questions involving prior authorization information and related processes. Analyze information to identify potential claim-processing issues and determine appropriate next steps. Communicate issues, trends, and concerns to management or appropriate internal teams. Accurately document claims, clinical inquiries, prior authorization information, and other customer interactions. Maintain confidentiality and handle healthcare-related information appropriately. Use established procedures, resources, and workflows when resolving inquiries. Communicate professionally and clearly with members, pharmacies, healthcare providers, and clients. Manage multiple tasks and priorities while maintaining accuracy and service quality. Participate in required training, coaching, and quality initiatives. Perform other duties as assigned. What We're Looking For We're looking for someone who is analytical, detail-oriented, solution-focused, and comfortable working with healthcare information and prescription claims. Successful candidates will demonstrate: Strong analytical and problem-solving skills. Excellent verbal and written communication skills. Strong customer service and interpersonal skills. Excellent attention to detail and accuracy. The ability to research information and determine appropriate next steps. The ability to multitask and prioritize competing demands. The ability to work effectively in a fast-paced healthcare contact center environment. Strong computer and data-entry skills. The ability to learn and navigate multiple software applications. Professional judgment and the ability to appropriately escalate issues. Dependability, accountability, and reliable attendance. The ability to work independently while contributing effectively as part of a remote team. Preferred Qualifications Two-year college degree in a related field. Two or more years of applicable healthcare, pharmacy, PBM, insurance, claims, or customer service experience. Pharmacy or pharmacy-benefit experience. Experience with prescription claims processing or claims adjudication systems. Experience with prior authorization processes. Experience supporting members, pharmacies, physicians, or healthcare providers. Experience in a healthcare contact center or customer support environment. Knowledge of prescription benefits or pharmacy benefit management. Experience using Microsoft Word, Excel, PowerPoint, and Outlook. Relevant experience may be considered in place of preferred education or other preferred qualifications when appropriate. Remote Work Requirements This is a 100% remote position and must be performed within the United States. Employees are responsible for providing and maintaining the equipment and internet connection necessary to perform the essential functions of the position. Minimum Computer & Equipment Requirements Windows 10 or Windows 11, 64-bit computer Minimum 8 GB RAM Quad-core processor or better At least 50 GB of available storage Second monitor with minimum 1920 × 1080 resolution USB noise-canceling headset with microphone Webcam Keyboard and mouse Minimum of two USB-A ports Minimum of one HDMI port Internet Requirements Minimum 50 Mbps download speed Minimum 50 Mbps upload speed Reliable internet connection capable of supporting continuous voice communication and required business applications Candidates should be prepared to demonstrate that their equipment and internet connection meet the minimum requirements before beginning employment. Schedule This is a full-time position of up to 40 hours per week. The regular operating schedule is Monday through Friday, with shifts scheduled through 10:00 PM Eastern Time . Occasional weekend coverage may be required based on business and client needs; weekend work is not necessarily required every week. Applicants must be able to work their assigned schedule consistently and maintain reliable attendance. Compensation & Benefits PharmaCentra offers competitive pay, growth opportunities, DailyPay for eligible employees, and a comprehensive benefits package. Benefits are available after 90 days of employment , subject to applicable plan terms and eligibility requirements, and include: Medical insurance Dental insurance Vision insurance Short-term and long-term disability coverage Life insurance Paid Time Off Paid holidays 401(k) retirement plan with company match DailyPay for eligible employees Why PharmaCentra? At PharmaCentra, healthcare is at the center of what we do. Our contact center professionals support programs for organizations across the healthcare industry, including pharmaceutical companies, PBMs, clinical research organizations, insurance providers, and hospital groups. You'll have the opportunity to use your healthcare knowledge, analytical skills, and customer service abilities to help people navigate complex healthcare-related questions-all while working remotely. If you're detail-oriented, solution-driven, and ready to build your career in healthcare services, we invite you to apply. Our application takes approximately 3 minutes and is mobile-friendly. Equal Employment Opportunity PharmaCentra LLC is an equal opportunity employer. Employment decisions are based on qualifications, merit, business needs, and other lawful considerations. PharmaCentra is committed to providing equal employment opportunities to qualified applicants and employees without regard to legally protected characteristics under applicable federal, state, or local law. PharmaCentra complies with applicable laws regarding reasonable accommodations for qualified individuals with disabilities and sincerely held religious beliefs. Applicants who require an accommodation during the application or hiring process may contact Human Resources for assistance. Apply today and join the PharmaCentra team! Offer of employment is conditioned upon passing a background check.