Note: The job is a remote job and is open to candidates in USA. Randstad Digital Americas is a staffing and workforce solutions company. The Representative I Clinical Services role provides telephone assistance and administrative support for criteria-based prior authorizations, including documenting cases, processing electronic requests, and routing complex clinical questions to pharmacists.
Responsibilities
- Handle inbound calls from providers, members, and pharmacies regarding prior authorization requests
- Process prior authorization paperwork received through ePA, fax, and departmental mailboxes
- Accurately document review details and escalate complex clinical decisions to the pharmacist team
- Conduct outbound calls to gather missing information and fulfill daily production goals
Skills
- High School Diploma or GED required
- 0–3 years of experience in prior authorization, call center, customer service, or data entry
- Basic understanding of pharmaceutical terminology, calculations, and protocols
- Dedicated private home office with a hardwired Ethernet connection (25 Mbps download / 3 Mbps upload minimum)
- Full availability for mandatory 1-month training (Monday – Friday, 8:00 AM – 4:30 PM EST)
Benefits
- Fully remote position
- Medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility)
Company Overview
Company H1B Sponsorship