Clinical Operations Associate

Clinical Operations Associate

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: Sunday - Thursday 8:30am - 5:00pm on-site in the PA or FL office (Sunday would be work from home)

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.
• Pharmacy Technician experience preferred.
• Previous experience in healthcare, pharmaceutical services, managed care or clinical operations preferred.
• Strong proficiency in Microsoft Office, including Excel and Word.
• 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

• Competitive salary
• 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