- Experience
- 2+ yrs
- Salary
- USD 28 – USD 28 / hour
- Openings
- 1
- Posted
- 5 days ago
- Work mode
- Work from home
- Education
- High school diploma
- Eligibility
- Candidates currently located in the continental United States who can work remotely and are willing to work any shift may apply. A current Pharmacy Technician certification and active license are required. Applicants should have at least 2 years of relevant pharmacy technician experience and 2 year…
- Resume
- Required to apply
Job description
About the company
Judi Health is a healthcare technology organization that builds software and services for employers, third-party administrators, and health plans. Its portfolio includes a full-service pharmacy benefit management offering, a broader health benefits management solution, and a proprietary enterprise platform that brings claim-administration workflows into one secure, scalable system. The company’s mission is centered on strengthening confidence in the U.S. healthcare experience and improving the infrastructure that supports care.
Role overview
This is a full-time remote opportunity open to candidates across the continental United States, with preference for applicants based in Hawaii. The role requires flexibility to work any shift. New hires will also complete training on a Monday through Friday schedule from 9:00 am to 5:30 pm Eastern.
What you will do
- Serve as the first point of contact for member calls, prior authorization questions, and related case routing, making sure intake details are captured and sent to the Clinical Prior Authorization team.
- Collect complete prior authorization information from prescribers and members by asking the needed drug-specific and client-specific clinical questions.
- Explain available exception options, such as formulary, copay, and early refill requests, using the member’s benefit setup as the guide, while also sharing status updates and other relevant information with prescribers, members, and pharmacies.
- Manage incoming calls from members, prescribers, and pharmacies efficiently and professionally, using probing questions to identify issues and close them out quickly.
- Support Customer Service Representatives when demand requires it by answering member and pharmacy inquiries and documenting concerns clearly.
- Communicate findings, issues, and resolutions to members, pharmacies, and internal partners while maintaining quality, safety, and service standards.
- Deliver a high level of customer care with empathy and professionalism in a fast-moving environment.
- Follow internal operating procedures, HIPAA requirements, company policies, and the company code of conduct, including reporting noncompliance when necessary.
- Help train and onboard new team members or temporary staff when needed.
- Assist the Fraud, Waste, and Abuse program by reviewing pharmacy claim information and sharing findings with the appropriate internal teams.
- Work across multiple systems at once, including using up to two monitors, while staying organized in a busy remote call-center setting.
- Maintain strong attendance, a positive attitude, and consistent productivity while meeting team goals for schedule adherence, attendance, and quality.
- Carry out other customer support tasks as assigned.
Required qualifications
- High school diploma or equivalent is required; an associate or bachelor’s degree is preferred.
- A current Pharmacy Technician certification (CPhT) and an active license are mandatory.
- At least 2 years of pharmacy technician experience in a clinical pharmacy environment, PBM, health plan, or a related healthcare setting is required.
- At least 2 years of customer service experience, with strong listening skills and the ability to build relationships through clear written and verbal communication, is required.
- Prior experience with prior authorization requests, or a solid understanding of prior authorization rules and processes, is preferred.
- Ability to work on your own with limited supervision in a remote, high-volume, fast-paced, metrics-based call center.
- Comfort using CRM tools, call center software, and Microsoft Office applications.
- Proven ability to meet performance standards for call quality, turnaround time, and customer satisfaction.
- A secure high-speed broadband connection at the remote work location is required; DSL, cable, or fiber are acceptable, and a 1 Gbps plan is required. Dial-up, satellite, Wi‑Fi, 5G, and cellular connections are not permitted.
Preferred experience and attributes
- Spanish fluency is highly preferred.
- Experience working with Medicare is preferred.
- Interest in healthcare and improving patient outcomes is valued.
- Adaptability in a startup or high-growth environment is a plus.
- Background in pharmacy operations or benefits administration is preferred.
- Commitment to diversity, equity, and inclusion is appreciated.
Compensation
The posted remote U.S. base pay range is $28 to $28 per hour.
Additional information
Applicants must be open to any shift. Standard training hours run Monday through Friday, 9:00 am to 5:30 pm Eastern. Employees must follow the company’s code of conduct, including reporting any noncompliance. The employer may modify duties or responsibilities as needed to support business goals. By applying, candidates agree that their personal data may be retained for consideration of future opportunities. The company also maintains a privacy policy governing personal data use.
Equal opportunity
The organization provides equal employment opportunities and does not discriminate or tolerate harassment on the basis of race, color, religion, age, sex, national origin, disability, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other legally protected characteristic.