Drug Prior Authorization Case Manager (Fully Remote)

Jobgether SRL; United States; Híbrido; USD 55.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Paid time off

Hybrid work

Health benefits

Descripción de la vacante

Jobgether is seeking a skilled claims specialist to manage end-to-end drug prior authorization and claims, ensuring adherence to clinical guidelines and plan provisions. You will support internal teams and external partners as a subject matter expert while driving continuous improvement.

The role emphasizes collaboration across departments, a hybrid work environment, and a focus on quality outcomes with competitive compensation and benefits.

Formación

• Post-secondary education or equivalent experience with 2–3 years in case management, claims, or customer-focused roles.
• Experience in group benefits, claims, disability management, or regulated environments.
• Strong analytical, communication, and problem-solving skills with proficiency in Microsoft Office 365.
• Competitive salary range with incentive programs and retirement savings options.
• Comprehensive health, dental, vision, and mental health coverage.
• Generous paid time off and flexible hybrid working environment.

Responsabilidades

• Handle intake, review, and adjudication of drug prior authorization requests with full ownership of cases.
• Communicate outcomes clearly and resolve escalated, high-value, and non-standard claims through detailed research.
• Apply risk-management principles and participate in operational efficiency and knowledge-sharing initiatives.

Conocimientos

Analytical

Communication

Problem solving

Case management

Educación

Post-secondary education

Herramientas

Microsoft Office 365

Descripción del empleo

• Manage end-to-end drug prior authorization and claims cases, evaluating requests against clinical guidelines and plan provisions.
• Support internal teams and external partners as a subject matter expert while driving continuous improvement.

Key Accountabilities:

• Handle intake, review, and adjudication of drug prior authorization requests with full ownership of cases.
• Communicate outcomes clearly and resolve escalated, high-value, and non-standard claims through detailed research.
• Apply risk-management principles and participate in operational efficiency and knowledge-sharing initiatives.

Qualifications:

• Post-secondary education or equivalent experience with 2–3 years in case management, claims, or customer-focused roles.
• Experience in group benefits, claims, disability management, or regulated environments.
• Strong analytical, communication, and problem-solving skills with proficiency in Microsoft Office 365.
• Competitive salary range with incentive programs and retirement savings options.
• Comprehensive health, dental, vision, and mental health coverage.
• Generous paid time off and flexible hybrid working environment.

Jobgether

The hiring company operates in the insurance and benefits sector, managing complex drug prior authorization and claims cases. It is a global organization with a collaborative culture that values flexibility, continuous improvement, and employee well-being.