Work At Home-Customer Service Representative-Healthcare

Explore meaningful roles that let you make an impact in healthcare while growing your career with purpose, innovation, and global opportunities. About Sagility Sagility combines industry‑leading technology and transformation‑driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries. Work From Home PharmD Utilization Management Pharmacist By combining cutting‑edge technology with decades of healthcare expertise, Sagility delivers exceptional results for our clients. In this full‑time, non‑patient‑facing role, you’ll review medication requests and apply clinical guidelines to ensure members receive appropriate, evidence‑based care. If you enjoy solving complex clinical scenarios, working independently, and contributing to meaningful healthcare outcomes, this opportunity is for you. S.O.A.R. Team Approach S - Spark Curiosity O - One Team, One Direction A - Action for Results R - Right by Right Purpose Benefits You Will Enjoy Competitive pay: $52.00/hour Performance‑based incentives Paid training in a cutting‑edge virtual training environment Comprehensive health coverage Employee wellness and engagement programs Daily Pay options available Medical, Dental, and Vision coverage Life Insurance Short‑Term and Long‑Term Disability options Flexible Spending Account (FSA) Employee Assistance Program 401(k) with employer contribution Paid Time Off (PTO) Tuition Reimbursement What You Will Do Evaluate clinical requests such as Prior Authorizations (PA), Formulary Exceptions (FE), Step Therapy (ST) requests, and Quantity Limit (QL) exceptions Apply clinical guidelines and client criteria to determine coverage decisions Interpret complex clinical scenarios and provide clear documentation supporting decisions Collaborate with pharmacists and team members to ensure consistency and accuracy Consult with healthcare providers when clarification is needed regarding clinical requests Meet productivity and quality benchmarks while maintaining strong attention to detail Support a culture focused on accuracy, accountability, and continuous learning What Makes You a Great Fit Doctor of Pharmacy (PharmD) degree Active pharmacist license in good standing 2–3 years of experience supporting U.S. healthcare pharmacy or utilization management processes preferred Strong clinical judgment and problem‑solving skills Comfortable working independently in a structured environment Strong written communication and documentation skills Ability to learn new systems quickly and manage multiple applications simultaneously Detail‑oriented with strong focus on accuracy and quality Hard‑wired internet connection with minimum speeds of 25 Mbps download and 10 Mbps upload Secure, private workspace free from distractions Work Environment & Schedule Work from Home Full‑time position supporting a volume‑driven healthcare environment Core business hours: 8:00 AM – 6:00 PM Central Time (schedules may vary based on business needs) Flexibility required for occasional overtime, weekend rotation (typically every 4–6 weeks), and select holidays (2–3 annually) Structured training program (approximately 5 weeks) to ensure confidence and success in the role What Success Looks Like High‑quality clinical decision‑making Consistent productivity aligned with team benchmarks Strong attention to detail and documentation accuracy Reliability, accountability, and professionalism Collaborative mindset and willingness to learn Sagility is an Equal Opportunity Employer/Veteran/Disability. Additional Requirements As a work‑from‑home team member, you are required to participate in active camera sessions throughout onboarding, training, and production. Failure to meet this expectation will result in separation from employment. Location: United States of America Join our team, we are looking forward to talking to you! #J-18808-Ljbffr View Moreicons