About Judi Health
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:
- Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions.
- Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans.
- Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows.
Position Responsibilities
- Act as the primary point of contact for incoming member calls and prior authorization inquiries, ensuring proper escalation to the Clinical Prior Authorization Team.
- Intake thorough prior authorization requests from prescribers and members by asking applicable drug and client-specific clinical questions.
- Advise callers on exception request options (formulary, copay, early refill) and provide status updates to relevant parties.
- Triage incoming calls with professional etiquette, using probing questions to resolve issues and address concerns promptly.
- Serve as a resource for other Customer Service Representatives, identifying and addressing concerns to ensure high-quality care.
- Effectively communicate resolutions to members, pharmacies, and internal stakeholders while adhering to HIPAA guidelines and Standard Operating Procedures.
- Assist with the onboarding and training of new team members as needed.
- Support the Fraud, Waste, and Abuse program by reviewing pharmacy claims information.
- Collaborate across multiple systems and monitors in a fast-paced, metric-driven environment.
Required Qualifications
- High school diploma or equivalent; associate or bachelor’s degree preferred.
- Current National Certification as a Pharmacy Technician (CPhT) and a valid license.
- 2+ years of pharmacy technician experience in a clinical pharmacy setting, PBM, or health plan.
- 2+ years of customer service experience with a focus on relationship building and communication.
- Experience handling prior authorization requests is highly preferred.
- Proficiency in CRM systems, call center platforms, and Microsoft Office Suite.
- Must maintain a secure, high-speed broadband connection (1 Gig plan required; no Wi-Fi, satellite, or cellular).