Prior Authorization Case Manager | Hybrid + Generous PTO

Jobgether SRL; United States; Hybrid; USD 55,000 - 90,000; Full time

Benefits offered by this job

Paid time off

Hybrid work

Health benefits

Job summary

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.

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.

Responsibilities

• 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.

Skills

Analytical

Communication

Problem solving

Case management

Education

Post-secondary education

Tools

Microsoft Office 365

Job description

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.