Job Description

About Judi Health & Capital Rx: Judi Health is a premier enterprise health technology firm modernizing healthcare infrastructure across the United States for employers, third-party administrators (TPAs), and health plans. Our ecosystem includes Capital Rx, a public benefit corporation delivering ethical, full-service pharmacy benefit management (PBM) solutions, and Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP) that consolidates high-scale claim administration workflows. Together, we are rebuilding trust in health benefits by replacing legacy bottlenecks with transparent, scalable, and secure cloud technology architectures.

Position Overview

We are seeking a highly systematic, compassionate, and metric-driven Customer Care Pharmacy Technician to join our decentralized clinical operations vertical under a permanent, full-time remote configuration open across the continental United States (with priority consideration extended to qualified candidates residing in Hawaii). In this critical health service seat, you will serve as the primary point of contact handling complex prior authorization inquiries, prescriber details, and tier-2 pharmacy benefit disputes. Shifting completely away from routine non-regulated data transcription data entry, generic text copywriting loops, or standalone software programming edits, you will run an active inbound case clinical intake, formulary exception mapping, and claim troubleshooting laboratory. This position requires a licensed pharmacy professional who structures patient support loops fluidly natively using Customer Support and PBM primitives, maintains rigorous compliance under strict HIPAA guidelines, addresses multi-system workflow demands using dual monitors, and optimizes case escalations alongside the Clinical Prior Authorization Team to secure high-quality health and safety outcomes.

Key Responsibilities

• Clinical Prior Authorization Governance: Manage and process initial intake files for complex drug exception requests from members and prescribers, ensuring complete details are routed to the Clinical Prior Authorization Team natively utilizing Customer Support frameworks.
• Formulary Exception Mapping: Counsel and advise pharmacies, doctors, and patients regarding early refill limits, copay tiers, and formulary switch options based on specific corporate client benefit elections.
• Inbound Technical Call Triage: Answer, probe, and troubleshoot live incoming telephone inquiries from medical practitioners and pharmacies with minimal operational oversight, maintaining immaculate professional phone etiquette.
• Customer Service Representative Escalation Support: Serve as an advanced subject matter expert and secondary tier anchor for entry-level Customer Service Representatives during high-volume call traffic surges.
• HIPAA & Regulatory Compliance Control: Adhere strictly to company standard operating procedures, data protection policies, and federal HIPAA privacy rules on every communication channel.
• Fraud, Waste, and Abuse Oversight: Support systemic corporate audit programs by reviewing automated pharmacy claim details, tracking anomalies, and flagging patterns for specialized internal teams.
• Cross-Functional System Multitasking: Orchestrate member profiles and benefits systems simultaneously using up to two display monitors under high-volume, remote call center parameters.
• Staff Onboarding Support: Assist with peer guidance, operational calibration, and software workflow training for incoming temporary staff or permanent technician hires.

Required Skills & Qualifications

• Possess a minimum of a High School Diploma or its equivalent; an Associate or Bachelor’s degree from an accredited institution is preferred.
• Mandatory Professional Credentials: Active National Certification as a Pharmacy Technician ( CPhT ) and a valid, uncompromised regional license are strictly required.
• A minimum of 2+ years of professional history operating as a pharmacy technician inside a clinical pharmacy, PBM setting, health plan, or equivalent regulated healthcare environment.
• A minimum of 2+ years of dedicated customer service, inside account assistance, or high-volume call center background with a passion for exceptional active listening.
• Strong, professional tool literacy navigating CRM software ecosystems, telephony software pipelines, and modern Microsoft Office suites.
• Mandatory Remote Infrastructure Demands: Access to a secure, private, low-noise home workstation equipped with a high-speed broadband internet layout (DSL, Cable, or Fiber) boasting a 1 Gig plan. Wireless WIFI, 5G, satellite, or cellular hotspot configurations are strictly unacceptable.
• Location Context: Position operates under 100% remote parameters open to qualified candidates residing within the United States (Continental US or Hawaii).

Preferred Strategic Indicators (Nice to Have)

• Highly fluent bilingual communication strengths in written and verbal Spanish are highly preferred.
• Direct operational knowledge or administrative experience navigating Medicare Part D parameters or managed care guidelines.
• Proven background adjusting tasks fluidly within a high-growth startup ecosystem or adapting to flexible shift schedules.

What We Offer

• Transparent & Equitable Remote Remuneration: A flat, competitive hourly base wage structure of $28.00 - $28.00 USD per hour , matched with performance incentives and departmental quality rewards.
• 100% remote workspace freedom from your home office setup, eliminating exhausting daily transit friction.
• Direct High-Volume Healthcare Impact: Unique professional growth milestones achieved by safeguarding the clinical intake channels that enable thousands of patients to access necessary medication safely.
• Comprehensive health care preservation benefits, providing high-tier Medical, Dental, and Vision coverage avenues alongside dedicated lifestyle wellness protections.
• Access to corporate 401(k) plans with employer matching components, regular culture committee connections, and structured continuous learning blocks.

Job Tags

Hourly pay, Permanent employment, Full time, Temporary work, Work at office, Remote work, Home office, Flexible hours, Shift work

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