Clinical Operations Representative

As a Remote Clinical Operations Representative you will assist in the daily activities of servicing customers and clients that include care providers and patients. This will include processing requests received via telephone, fax, and e-mail, and providing or validating requested information. This position plays an important role in gathering necessary data for the Utilization Management department.  The ideal candidate will have great attention to detail and advanced grammar and punctuation skills. This position is full-time with variable shifts.


  • Responds to customer questions via telephone and written correspondence regarding medical cases
  • Thoroughly documents inquiry outcomes for accurate tracking and analysis
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and inquiries are handled appropriately and in a timely manner
  • Responsible for meeting or exceeding quality and productivity expectations to ensure customer satisfaction
  • Reviews and maintains service requests and call center database for completeness of information
  • Handles most complex calls with minimal assistance. Provides assistance with and/or refers high-level, complex questions, problems, or client complaints to appropriate resources to ensure customer satisfaction
  • Enters updates to pertinent insurance data in a timely manner.  Ensures accuracy and completeness of data entries and adheres to department protocols and policies.
  • Performs outbound calls to members, providers, and clients
  • Respects and maintains HIPAA confidentiality guidelines
  • Other duties as assigned


  • Minimum of 3 years’ experience in customer service or healthcare operations required.  A Medical Assistant Certification is a plus!
  • Associates Degree in a business or health-related field is preferred
  • Demonstrated dependability and reliability
  • Strong problem-solving and troubleshooting skills with excellent attention to detail
  • Phone queue experience and data entry skills preferred
  • Intermediate to advanced proficiency in Microsoft Word, Excel, and Outlook
  • Strong organizational skills and ability to multitask

Apply Now

NCQA icon
©2021 TurningPoint Healthcare Solutions LLC.  |  Member Rights & Responsibilities | Clinical Policies & Guidelines