Drug Prior Authorization Case Manager

Role Overview:

• 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.

Benefits:

• 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.