Representative I, Clinical Services

The Rep I, Clinical Services takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.

The Rep I, Clinical Services will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auths received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.

RAMP TIMELINE:
Last Offer: 10/05/2026
Last Acceptance: 10/08/2026
Must clear prior to: 10/19/2026

Please include screenshot of speed test at top of resume.

Prescreen Questionnaire must be listed at top of Resume
1. Do you have prior authorization experience
- If yes, how many years
2. Do you have experience working remotely
- If yes, how many months
3. Do you have call center experience
- If yes, how many months
4. Do you have healthcare industry experience
- If yes, please briefly describe:
5. Is your home internet setup hardwired (Ethernet connection)
6. Do you have a private, distraction-free workspace at home
7. Are you available to work EST hours during the 1-month training period
8. Are you able to commit to no time off during the training period

Candidate must complete a free online computer skills assessment and attach results to the top of the resume

Remote Work Requirements

Candidates must meet all requirements below:
Hardwired internet connection required (Wi-Fi only is not acceptable)
Internet speed test screenshot required with submission
Minimum 25 Mbps download and 3 Mbps upload
Private, HIPAA-compliant workspace required
Ability to work on a computer for the duration of the shift
Smartphone required for use of the PING application
Training schedule is Monday-Friday 8-4:30pm EST. Regular shift to be determined after training by based on business needs.

The Intake I (IQA) Associate takes in-bound calls (high volume) from members, providers, etc providing professional phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of all requests, and transfers all clinical questions and judgement calls to the nurse or pharmacist. The Intake I (IQA) Associate will also assist with other duties such as outbound calls, monitoring/responding to inquiries in mailboxes and other duties as assigned by the leadership team.

1.Strong Attention to detail
2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality
3.Proficient computer skills and the ability to navigate in a Windows based environment
4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible
5.Ability to work in a high pressure, time sensitive environment
6.Project a professional business image, through phone interaction as well as internal communications
7.Demonstrated problem-solving ability and attention to detail
8.Demonstrated sense of urgency with assignments
9.Strong organizational skills 10.Strong telephone skills
11.Ability to read and understand pharmacy/medical terminology
12.Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations.
13.Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required
14.Ability to interpret a variety of work instructions provided through a variety of mediums
15.Ability to anticipate needs and resolve issues with urgency
16.Ability to consistently meet quality and production standards
17.Displays confidence in the ability to learn complex material
18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results

Training schedule is approximately four weeks starting Monday to Friday 8am-4:30pm ET, then schedule will be assigned: Expected shifts to be 8 hours per day, Position requires schedule flexibility. Weekend and evening shifts may be required. Permanent schedule to be decided after training. Phone hours are from 9am-7pm ET.

Intake Call Notes:
Training Duration: 1 month (no time off allowed during training)
Training Hours: EST; post-training schedules can be flexible across time zones
Work Environment: Fully remote; candidates must be hardwired (Ethernet) and have a private, distraction-free workspace
Internet speed test screenshot required at top of resume
Required Experience: 03 years related experience, prior authorization, data entry, customer service
Preferred Experience: Healthcare industry, call center (minimum 6 months), remote work (minimum 6 months)
Resume Requirements: Internet speed test screenshot and highlighted healthcare experience (this is a plus)
Prescreen questionnaire to be added for quick resume review

Duties
The Representative I, Clinical Services takes in-bound calls from providers, pharmacies, and members etc, providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.

The Rep I, Clinical Services will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auths received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.

Experience
Required Qualifications
- Ability to apply basic computer skills.
- Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable.
- Keyboard skills are essential.
- Must be able to multitask and utilize multiple system applications simultaneously.
- Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.

Preferred Qualifications
- Prior authorization experience
- Must be able to utilize available resources independently and provide high quality work.
- Must be able to absorb presented information, display motivation, seek development and problem solve.
- Ability to adapt and change with workflow and shifting priorities.
- Must possess excellent written, verbal, grammar, and listening communication skills.
- Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.
- Ability to maintain confidentiality of PHI (Protected Healthcare Information).
- Associate Degree or Bachelors Degree

Position Summary
The Representative I, Clinical Services takes in-bound calls from providers, pharmacies, and members etc, providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.
The Rep I, Clinical Services will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auths received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.

Education
High School diploma or GED

What days & hours will the person work in this position List training hours, if different.
anywhere from 8am to 11pm EST, 8 hours per day/ 40 hours per week. Training 8am-4:30pm EST.