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Customer Service
Clinical Care Representative
@Truescripts Management Services
[Hiring] Clinical Care Representative @Truescripts Management Services
Mar 30, 2025 - Truescripts Management Services is hiring a remote Clinical Care Representative. 💸 Salary: unspecified. 📍Location: USA.
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
The Clinical Care Representative is responsible for performing all clinical tasks relative to in-house and external communications with TrueScripts clients, members, pharmacies, and physicians. This role responds to clinical inquiries, prior authorization requests, and paper claims requests, analyzes data, assists members with prescription benefits, and problem-solves in the claims system. Additional responsibilities include logging and preparing client invoices and providing administrative support to management.
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Account Inquiries & Claims Processing
- Receive phone calls/emails/faxes from members, clients, pharmacies, and/or physician offices.
- Assist Member Care Representatives with clinical calls.
- Troubleshoot claim processing problems and/or inquiries in the claims adjudication system.
- Respond to website inquiries.
- Complete Prior Authorization requests.
- Become proficient in all aspects of the claims adjudication system.
- Communicates problems and concerns to the manager.
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Consulting Services Support
- Work with Rx data in Excel and/or TrueScripts dashboard.
- Reach out to members to assist in a change of Rx to a more cost-effective generic alternative.
- Provide members with co-pay assistance for brand and specialty medications.
- Act as patient advocates when excluded medications are identified – communicate effectively with all parties involved.
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Claims Logging, Invoicing & Reporting
- Log Specialty Care, Brand Care, Paper Claims, and Fee for Prior Authorizations on SharePoint.
- Log Specialty and Non-Specialty Prior Authorization approvals on SharePoint.
- Prepare and send weekly/monthly invoices to the Accounting team.
- Document actions and outcomes in the client database.
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Administrative Support
- Identify process/procedure improvements and update documents on SharePoint.
- Schedule meetings/conference calls as requested.
- Assist with creating/updating marketing materials in Publisher/Word.
- Assist Data Analytics team with report preparation for client annual reviews in Excel.
- Performs other duties as assigned.
Qualifications
- Associate degree - related field preferred, but not required.
Requirements
- Active pharmacy technician preferred, but not required.
- Two years of applicable experience preferred.
- Experienced pharmacy tech experience preferred but not required.
- Knowledge of claims processing helpful.
- Analytical thinking and attention to detail.
- Problem-solving skills.
- Excellent communication and customer relations skills.
- Ability to multi-task and prioritize in an ever-changing environment.
- Strong computer skills including Microsoft Office (Excel, Word, PowerPoint, Outlook).
Benefits
- Robust benefits and a strong salary.
- ESOP - Team Member Owned.
- Employee Assistance Program.
- Wellness Program.
- Dream Manager Program (yes, it’s a real thing!).
- A cohesive, family-based culture.
- Charitable contributions.
- Paid Volunteer Time.
- Lots of celebrations!
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| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
Back to Remote jobs >
Customer Service
Customer Service
|
Salary
💸
unspecified
|
Remote
Location
USA
|
|
Job Type
full-time
|
Posted
Mar 30, 2025
|
️
| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
