Clinical Operations Associate - BeneCard PBF

BeneCard PBF; Town of Florida (NY); On-site; USD 42,000 - 63,000; Full time

Benefits offered by this job

Vacation and Sick/Personal Time

Medical Insurance

401(k)

Professional Development Training

Job summary

BeneCard PBF is seeking a detail-oriented Clinical Operations Associate to support clinical and operational processes for PBM services for commercial health plan members. Roles include reviewing clinical requests, communicating with pharmacies, prescribers, and members, and processing prior authorizations in a fast-paced healthcare environment.

The ideal candidate has pharmacy technician or healthcare operations experience and strong communication skills, with proficiency in Microsoft Office.

Qualifications

• High school diploma or equivalent required.
• Previous experience in healthcare, pharmaceutical services, managed care or clinical operations required.
• Strong proficiency in Microsoft Office, including Excel and Word.

Responsibilities

• Review and process clinical requests from pharmacies, healthcare providers, members, and other stakeholders.
• Determine appropriate actions based on clinical and operational guidelines.
• Contact pharmacies, prescribers, and members by phone to obtain or provide necessary information.
• Handle incoming calls from prescribers and accurately document conversations and requests.
• Review prior authorization submissions, data verification requests, and information received from internal departments.
• Enter overrides and process clinical determinations within system platforms.
• Generate and distribute decision notification letters and required documentation.
• Maintain accurate records while adhering to company policies and regulatory requirements.

Skills

Communication

Multitasking

Customer service

Pharmacy knowledge

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

Clinical Operations Associate - BeneCard PBF

Full Time Florida, Bonita Springs, FL, US

BeneCard PBF is seeking a detail-oriented Clinical Operations Associate to support clinical and operational processes related to pharmacy benefit management (PBM) services for commercial health plan members. This role is ideal for candidates with pharmacy technician experience, healthcare operations experience, or a background in managed care who thrive in a fast-paced environment and enjoy delivering exceptional customer service.

As a Clinical Operations Associate, you will review clinical requests, communicate with pharmacies, prescribers, and members, process prior authorization information, enter overrides, and ensure accurate documentation and decision notifications. The successful candidate will possess strong communication skills, technical proficiency, and the ability to manage multiple tasks efficiently.

Working Hours -Candidates must be flexible to work one of the following schedules:

• Schedule 1: Monday-Friday 11:30am-8:00pm


• Schedule 2: Tuesday-Saturday 8:30am-5:00pm


• Schedule 3: Sunday-Thursday 8:30am-5:00pm

Key Responsibilities

• Review and process clinical requests from pharmacies, healthcare providers, members, and other stakeholders.


• Determine appropriate actions based on clinical and operational guidelines.


• Contact pharmacies, prescribers, and members by phone to obtain or provide necessary information.


• Handle incoming calls from prescribers and accurately document conversations and requests.


• Review prior authorization submissions, data verification requests, and information received from internal departments.


• Enter overrides and process clinical determinations within system platforms.


• Generate and distribute decision notification letters and required documentation.


• Maintain accurate records while adhering to company policies and regulatory requirements.


• Perform additional duties and special projects as assigned.

Qualifications

• High school diploma or equivalent required.


• Previous experience in healthcare, pharmaceutical services, managed care or clinical operations required.


• Strong proficiency in Microsoft Office, including Excel and Word required.


• Ability to learn new software applications and navigate multiple systems simultaneously.


• Excellent organizational skills with the ability to multitask in a fast-paced environment.


• Exceptional verbal and written communication skills in English.


• Dependable, professional, outgoing, and customer focused.

Featured Benefits

• Vacation and Sick/Personal Time


• Medical Insurance


• Hearing Program Discount


• Short- & Long-Term Disability Insurance


• Life Insurance


• Flexible Spending Account


• 401(k)


• Employee Referral Program


• Employee Recognition


• Tuition Reimbursement


• Professional Development Training

About Benecard Services our affiliated companies:

Benecard Services, LLC has been administering carve-out, fixed rate insured prescription drug benefit programs since 1990. Benecard is a full service, in-house prescription benefit administrator that includes mail and specialty drug dispensing. We are a premiere nationwide Prescription Benefit Administrator headquartered in Lawrenceville, New Jersey.

BeneCard PBF provides self-funded prescription benefit program administration with a personalized approach through focused, clinical expertise. Our business model operates on a customized claim processing system offering unlimited capability and flexibility to respond to client needs in an evolving marketplace. Advanced clinical programs and advanced technology provide the framework to maximize the use of all data elements available. This allows BeneCard PBF to filter the information, focus on clinical opportunities and facilitate interaction between the physician, the pharmacist and the patient to effectively promote complete health care. Headquartered in Bonita Springs, Florida.

For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health & Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.