Clinical Associate, Pharmacy Benefits & Appeals

The OccuNet Company; Amarillo (TX); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

401(k) with matching

Dental insurance

Health insurance

Vision insurance

Health savings account

Paid time off

Job summary

The OccuNet Company is seeking a FairosRx Clinical Associate to support pharmacy benefit operations by coordinating clinical and administrative workflows, reviewing documentation, and communicating with members, providers, pharmacy staff, clients, and internal stakeholders.

The role helps ensure accurate, timely, and compliant processing of pharmacy benefit requests while supporting service quality and operational efficiency.

Qualifications

• Excellent communication and interpersonal skills, written and verbal.
• Able to multi-task effectively and transition between tasks frequently and maintain focus when presented with interruptions.
• Proficient computer skills, including Microsoft Office Suite.
• PBM experience preferred.
• Team-first mindset with a high level of motivation and drive.

Responsibilities

• Collect, verify, and document clinical information from providers, pharmacies, and members.
• Assist pharmacists with utilization management, coverage determinations, and appeals processing.
• Monitor work queues and meet productivity, quality, and turnaround time expectations.
• Process pharmacy claims and resolve claim adjudication issues.
• Research member eligibility, benefit coverage, and medication history.
• Communicate with prescribers, pharmacies, and members regarding authorization status, coverage requirements, and alternative therapies.
• Provide customer service and respond to inquiries related to pharmacy benefits and medication coverage.
• Maintain accurate case documentation in pharmacy management systems.
• Support formulary management initiatives, including step therapy and quantity limit programs.
• Ensure compliance with HIPAA, client requirements, and regulatory standards.
• Maintain confidentiality of protected health information.

Skills

Communication skills

Multitasking

Microsoft Office

PBM experience

Team player

Project management

CPhT certification

Education

High school diploma or equivalent

Tools

Microsoft Office Suite

Job description

The OccuNet Company is seeking a FairosRx Clinical Associate to support pharmacy benefit operations by coordinating clinical and administrative workflows, reviewing documentation, and communicating with members, providers, pharmacy staff, clients, and internal stakeholders.

The role helps ensure accurate, timely, and compliant processing of pharmacy benefit requests while supporting service quality and operational efficiency.