On-Site Clinical Ops Specialist - Claims & PA

Empirx-Health-4; Montvale (NJ); On-site; USD 51,000 - 64,000; Full time

Benefits offered by this job

Paid Time Off

401(k) program

Health Insurance including Dental &amp

Student Loan Reimbursement

Health Savings Account

Employee Assistance Program

Job summary

EmpiRx Health is seeking a Clinical Operations Specialist to provide administrative and operational support to adjudication and clinical review teams in Montvale, NJ. The role emphasizes accurate processing of overrides and prior authorizations to ensure timely service and compliance.

The ideal candidate brings a minimum of 5 years in pharmacy, with at least 2 years in claims adjudication and 2 in prior authorization, strong Microsoft Office skills, and a proven ability to manage multiple

Qualifications

• Minimum 5 years of pharmacy experience, including at least 2 years in claims adjudication and 2 years in prior authorization processes.
• 2 years of experience in a PBM, health plan, or related healthcare environment preferred.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Exceptional attention to detail and organizational skills.
• Strong customer service orientation and interpersonal skills.
• Must be able to work on-site five days per week.

Responsibilities

• Provide administrative and operational support to adjudication, prior authorization, and clinical review teams.
• Accurately process claim overrides and case documentation per SOPs.
• Ensure turnaround times and quality metrics are met.
• Collaborate with clinical pharmacists, call center reps, and internal stakeholders.
• Maintain 2-hour SLA for escalation requests.
• Proactively monitor case queues to ensure timely follow-up and resolution.
• Escalate high-priority or complex issues promptly to leadership.
• Partner with internal departments to deliver seamless issue resolution.
• Maintain a proactive and solutions-focused approach in all interactions.

Skills

MS Office

Attention to detail

Customer service

Deadline management

Critical thinking

On-site availability

Education

High school diploma

Job description

EmpiRx Health is seeking a Clinical Operations Specialist to provide administrative and operational support to adjudication and clinical review teams in Montvale, NJ. The role emphasizes accurate processing of overrides and prior authorizations to ensure timely service and compliance.

The ideal candidate brings a minimum of 5 years in pharmacy, with at least 2 years in claims adjudication and 2 in prior authorization, strong Microsoft Office skills, and a proven ability to manage multiple