Operations Specialist | Bilingual (Spanish)

Job Description

CSS Health, a division of Clarest Health, is a software company that supports health insurance companies through software solutions and outsourced services. We help manage Medicare Part D Medication Therapy Management (MTM) programs and provide clinical and operational support to help our clients deliver quality care to their members.\n
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\nThe Operations Specialist supports Clarest Path’s Medication Therapy Management (MTM) programs by managing work queues, maintaining accurate member documentation, and completing outbound outreach as needed. This role helps ensure information is processed accurately and timely while supporting clinical workflows in a fast-paced healthcare operations environment.\n
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\nLocation: Remote – Bilingual English/Spanish\n
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\nSalary: $20 - $22 per hour, depending on experience\n
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\nSchedule: Monday – Friday | 9:00AM - 5:30PM EST\n
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\nWhat We Offer:\n
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• Paid Training
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• Comprehensive Medical, Dental, and Vision Insurance (plans starting as low as $13.73 per pay period)
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• Free Virtual Care and Telemedicine Services
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• Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA)
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• 14 Days PTO in Year 1 | Increased in Year 2
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• 401k with company match
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• Employee Referral Bonuses
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• Corporate Discount Program
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• Health and Wellness Apps and Support
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• Life Insurance
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• Pet Insurance
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• Legal Insurance
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• Make a difference in the lives of others!
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• We are growing and that means more opportunities

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Key Responsibilities:\n
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• Manage assigned operational work queues, ensuring tasks are completed accurately and within required turnaround times.
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• Review and update member records using established workflows and decision-making guidelines.
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• Conduct outbound Point of Access (POA) calls for member enrollment and eligibility verification as needed.
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• Perform outreach to providers and pharmacies to resolve missing information, clarification requests, and other MTM-related issues.
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• Process incoming faxes and returned mail, including accurate indexing, documentation, routing, and account updates.
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• Enter required documentation, including Summaries of Findings, into the appropriate systems.
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• Identify workflow issues or trends and escalate concerns appropriately.
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• Maintain compliance with HIPAA, privacy, security, and company policies when handling protected health information.

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Qualifications:\n
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• High school diploma or GED required.
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• At least 1 year of experience in a call center, healthcare operations, or administrative support environment.
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• Previous telephone outreach experience with patients, members, providers, or pharmacies preferred.
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• Experience with Microsoft Office, including Excel and Word.
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• Comfortable learning and working in multiple computer systems and platforms.
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• Familiarity with Medication Therapy Management (MTM) programs or healthcare documentation workflows preferred.

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Skills + Abilities:\n
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• Demonstrates professional and courteous telephone etiquette when communicating with members, providers, pharmacies, and internal teams.
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• Comfortable learning new systems, processes, and technology and able to adapt quickly as priorities and workflows change.
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• Able to work independently, take initiative, and stay productive with limited day-to-day supervision.
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• Strong computer skills, with the ability to navigate and multitask across multiple programs and systems.
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• Knowledge of Microsoft Excel preferred.
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• Strong organizational and time-management skills, with the ability to prioritize multiple tasks and meet deadlines.
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• Dependable and reliable, consistent attendance and punctuality.
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• Strong team orientation and willingness to actively contribute, communicate, and support coworkers to achieve shared goals.
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• Strong attention to detail and ability to maintain accuracy while working in a fast-paced environment.

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Clarest is an Equal Opportunity Employer. Reasonable accommodations will be made to enable individuals with disabilities to apply for a job or perform the essential functions of their job. Please advise us if you require a reasonable accommodation.