Shire Jobs

What You'll Do:As a Clinical Operations Specialist, your role will encompass a wide range of responsibilities:Serve as an account support to internal EmpiRx Health teams for adjudication, clinical review, and claims support-related matters.Ensure timely completion of day-to-day processes and assigned cases, adhering to standard operating procedures.Address escalation requests within a targeted 2-hour turnaround time.Manage claims override and prior authorization support, delivering exceptional white-glove service to clients and members.Act as a subject matter expert on the adjudication platform, demonstrating a keen understanding of claims support.Perform under the supervision of the ClinOps Manager and clinical pharmacists.Effectively communicate and interact with all other EmpiRx Health departments, fostering teamwork and unity.What You Need:Minimum five years of pharmacy experienceCPhT certificationMinimum two years of claim adjudication experienceMinimum two years of prior authorization experienceStrong customer service orientation and commitment to delivering concierge-level service.Ability to work in a fast-paced environment.Time management skills with the ability to meet tight deadlines.Excellent verbal and written communication skillsProficient in Microsoft Office SuiteBS (Bachelor's) PreferredTwo years of experience in PBM, health plan, or equivalent preferredAbility to work in office 5 days per week.