Senior Clinical Operations Technician: UM & Authorizations

Prime Therapeutics; Springfield (IL); On-site; USD 266,000 - 397,000; Full time

Job summary

Prime Therapeutics is seeking a Commercial Sr Technician to process complex formulary exceptions, prior authorizations, and brand overrides for UM products and services. The role acts as a technical resource for client-specific processes and complex case research.

The Senior Clinical Operations Technician will coordinate with internal reviewers, respond to escalations, and ensure accurate adjudication and documentation across claims systems.

Qualifications

• High school diploma or GED required.
• 2 years pharmacy or health care delivery experience preferred.
• Eligible to work in the United States without visa sponsorship.

Responsibilities

• Serve as a point of contact for reviewers with guidance on complex cases.
• Respond to escalated calls from the Contact Center and providers with accurate information.
• Enter and update prior authorizations, approvals, or denials in system records.
• Monitor inboxes and工作 queues across multiple areas to meet turnaround targets.
• Coordinate information collection from pharmacies and physician offices for UM requests.
• Provide clinical information to pharmacists and physicians to support decisions.

Skills

Attention to detail

Communication skills

Problem solving

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Prime Therapeutics is seeking a Commercial Sr Technician to process complex formulary exceptions, prior authorizations, and brand overrides for UM products and services. The role acts as a technical resource for client-specific processes and complex case research.

The Senior Clinical Operations Technician will coordinate with internal reviewers, respond to escalations, and ensure accurate adjudication and documentation across claims systems.