Orlando On-Site Clinical Ops Specialist — PBM Claims & PA

EmpiRx Health, LLC.; Orlando (FL); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Paid Time Off

401(k) plan

Health Insurance including Dental & V…

Student Loan Reimbursement

Health Savings Account

Employee Assistance Program

Job summary

EmpiRx Health, a leading clinically-driven PBM, seeks a Clinical Operations Specialist to provide administrative and operational support to adjudication and clinical review teams in Orlando, FL. This on-site role emphasizes accurate processing of overrides and prior authorizations to support high-quality service.

The ideal candidate has 5+ years in pharmacy with claims adjudication and PA experience, strong MS Office skills, and a detail-oriented, customer-focused approach within a fast-paced,

Qualifications

• Minimum 5 years of pharmacy experience with 2 years in claims adjudication and 2 years in prior authorization processes.
• 2+ years in a PBM, health plan, or related healthcare environment preferred.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).

Responsibilities

• Provide administrative and operational support to adjudication, prior authorization, and clinical review teams.
• Process claim overrides and case documentation per SOPs.
• Maintain turnaround times and quality metrics to meet client expectations.
• Assist clinical pharmacists and ops teams with workflow reporting.
• Meet case completion targets and adhere to a 2-hour SLA for escalations.
• Collaborate with internal stakeholders to ensure efficient case handling.
• Support special projects or workflow initiatives as directed.

Skills

Attention to detail

Organizational skills

Customer service orientation

Interpersonal skills

Ability to meet deadlines

Critical thinking

Problem-solving abilities

Education

High school diploma

Tools

Microsoft Office Suite

Job description

EmpiRx Health, a leading clinically-driven PBM, seeks a Clinical Operations Specialist to provide administrative and operational support to adjudication and clinical review teams in Orlando, FL. This on-site role emphasizes accurate processing of overrides and prior authorizations to support high-quality service.

The ideal candidate has 5+ years in pharmacy with claims adjudication and PA experience, strong MS Office skills, and a detail-oriented, customer-focused approach within a fast-paced,