Client Operations Specialist

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $24 - $28 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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LucyRx

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Seed on 2025-05

Healthcare • Healthcare Insurance • Pharmaceuticals

LucyRx is a fast-scaling, independent, next-generation pharmacy benefit manager (PBM) that reimagines prescription care for plan sponsors, members, and providers nationwide. The company emphasizes transparency, conflict-free economics, customizable formularies and plan designs, and personalized member support to lower costs and improve health outcomes. LucyRx positions itself as a partner to employers and health plans, offering services to clarify hidden costs, optimize rebate performance, and deliver proactive client support.

📋 Description

• Manage texts, service emails, incoming calls, and voicemail • Serve as an escalation point for Helpdesk issues and resolve calls and questions not handled by Helpdesk agents • Maintain and update Helpdesk instructions and protocols • Respond to prior authorization status inquiries from providers and partner vendors • Resolve member coverage, cost, card, and prior authorization clinical criteria inquiries • Print and mail prior authorization denial letters • Assist members with portal registration and claims viewing for dependents • Enter rejection overrides and assist pharmacies with claim adjudication • Review and triage prior authorization tickets, remove duplicates, and archive inactive or aged tickets • Update provider fax information and resend prior authorization forms or decision faxes • Coordinate data collection for new accounts and renewals • Prepare implementation, plan change, legal, account structure, and drug/product list documents • Run claims testing to validate configuration accuracy • Attend weekly client meetings and track open issues • Maintain portal access, invoice, report, and rebate recipient records • Conduct portal tutorials and resolve report discrepancies • Create client-facing lists and collateral with the Marketing team • Provide census files and member contact information to partners and vendors • Send prior authorization approval and rejection summaries to partners and vendors • Notify clients and agents of formulary changes and member impacts • Review invoices, complete clinical reports, and create custom reports • Review reimbursement requests and disputed claims for eligibility and programming accuracy • Investigate accumulator discrepancies and eligibility file issues • Submit eligibility corrections and refund reports to the appropriate teams

🎯 Requirements

• Prior experience in pharmacy benefits, PBM operations, health plan administration, or a related account/client support role preferred • Strong attention to detail and accuracy, particularly with data entry, claims, and configuration work • Excellent written and verbal communication skills • Ability to manage multiple queues, tickets, and deadlines simultaneously • Comfort working with spreadsheets, data files, and basic reporting tools • Strong problem-solving skills and ability to research and resolve discrepancies independently • Ability to collaborate cross-functionally with internal teams • Largely sedentary role; ability to perform some standing, walking, bending, and reaching • Ability to operate a computer, mouse, keyboard, printer, copier, phone, and other standard office equipment

🏖️ Benefits

• Remote-first team • Supportive culture encouraging employees to bring their whole self to work • Opportunities to grow alongside colleagues • Minimal travel may be required

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