Review, process, and troubleshoot incoming Prior Authorization requests for various medications.
Accurately process requests according to regulatory and client-specific guidelines while meeting departmental performance metrics.
Work with clinical teams and handle requests via phone, fax, and web submission.
Navitus is a pharmacy benefit manager (PBM) alternative focused on reducing drug costs to make medications more affordable. The company offers a diverse and creative work environment with numerous employee benefits and growth opportunities.
Review and process prior authorization requests for various medications.
Communicate prior authorization criteria to providers and act as a help desk.
Process requests via phone, fax, and web submission while maintaining HIPAA compliance.
Lumicera Health Services is a specialty pharmacy focused on optimizing patient well-being through transparency and stewardship. It fosters a diverse and creative work environment as part of the Navitus organization.
Manage accident-related accounts from intake to resolution, coordinating no-fault and liability benefits.
Submit claims to carriers, maintain accurate records in AcciClaim, and monitor insurance portals.
Work independently, set priorities, and communicate professionally with patients and adjusters.
Revecore helps hospitals recover revenue they've earned so they can continue serving patients and communities. Trusted by more than 1,300 hospitals across 48 states, the company combines specialized expertise with proprietary technology and fosters a supportive, innovative workplace.
Lead medical information activities for healthcare programs, ensuring high-quality handling of inquiries.
Ensure accurate documentation and triage of medical requests, adverse events, and product complaints.
Manage multiple projects and maintain empathetic customer communication across channels.
The hiring company focuses on delivering medical information and healthcare support programs. It operates with a remote team culture, emphasizing collaboration and professional development.
Assist patients with enrolling in our Prescription Payment Plan and verifying eligibility.
Coordinate with pharmacies to apply benefits and reduce out-of-pocket costs.
Guide patients through renewals and updates to ensure continued access.
We are a team dedicated to improving access to affordable prescription medications for patients. We partner with insurance companies, healthcare providers, and pharmacies to reduce the financial burden of medications, ensuring patients can access treatments without excessive costs.
Review prior authorization cases to ensure clinical and operational standards are met.
Audit AI outputs, third-party reviews, and internal decisions for accuracy and compliance.
Collaborate cross-functionally to refine workflows and improve patient access to treatment.
Generator Health operates a platform that streamlines prior authorization processes for patients and providers. They handle tens of thousands of patients weekly and emphasize collaboration and accuracy in a high-autonomy remote environment.
Conducts outreach to members, prescribers, and infusion providers to facilitate site-of-care transitions and support informed healthcare decisions.
Manages case workloads, tracks referral progress, and coordinates with internal and external stakeholders to ensure timely service delivery.
Documents activities, identifies barriers, and contributes to process improvements to enhance program effectiveness and member outcomes.
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. It replaces fragmented, outdated systems with a unified claims processing architecture to drive operational efficiency for millions of Americans.
Verify insurance, obtain benefits, calculate estimates, and secure prior authorizations for outpatient services.
Act as liaison between payers and clinic staff; follow up on denied or delayed authorizations.
Maintain detailed documentation and resolve issues with physicians, nurses, and financial advocates.
University of Utah Health is a patient-focused organization enhancing health through care, research, and education. It operates five hospitals and eleven clinics with a culture of collaboration, excellence, leadership, and respect.
Manages claim strategies and resolutions while advocating for optimal client outcomes.
Communicates claim information to internal and external clients and maintains strong relationships.
Develops expertise in multiple coverage lines and participates in presentations and new business pitches.
IMA Financial Group is an independent insurance brokerage providing risk management, employee benefits, and wealth management solutions. With a focus on associate ownership and team-based culture, the company has been recognized as a best place to work by multiple publications and operates nationally.
Assess member needs across physical health, mental health, SUD, oral health, and social supports.
Develop and oversee client care plans, set SMART goals, and evaluate progress.
Coordinate with healthcare providers, connect clients to community services, and advocate on their behalf.
Vynca is a healthcare company dedicated to transforming care for individuals with complex needs, focusing on providing comprehensive care for more quality days at home. They are a close-knit community committed to core values of Excellence, Compassion, Curiosity, and Integrity, fostering an inclusive workplace.
Supervise and advise claims examiners in all phases of the adjudication process and ensure compliance with regulations and departmental standards.
Manage workflow, caseload challenges, and team performance to meet production goals and quality standards.
Act as subject matter expert for complex claims, provide coaching and training, and participate in hiring and performance evaluations.
Protective helps protect customers against life's uncertainties by providing insurance and peace of mind. The company is focused on employee wellbeing and offers a broad benefits package including health, financial, and paid time away.
Manage a caseload of in-progress insurance applications through underwriting, navigating tools like HubSpot and Front.
Coordinate medical exams, track requirements, handle inbound calls/emails, and process policy changes.
Collaborate with internal teams and contribute to process improvements to enhance customer experience.
PolicyMe is a Toronto-based digital insurance startup modernizing the insurance industry in Canada, offering life, critical illness, and health & dental insurance. The company has grown exponentially since 2018, selling over $10 billion in coverage, and operates with a remote-first, low-ego culture attracting top talent across the country.
Own and manage an individual caseload of in-process life insurance applications from submission to placement.
Request and review underwriting requirements to determine if better options exist for customers.
Collaborate on cross-functional projects with sales, customer service, and quality assurance teams.
Zinnia is the leading technology platform for accelerating life and annuities growth, simplifying buying, selling, and administering insurance products. With $180 billion in assets under administration, Zinnia serves 100+ carriers, 2500 distributors, and 2 million policyholders and values being bold, teaming up, and delivering value.
Respond to service requests from internal and external customers accurately and on time.
Maintain case documentation with precision to keep records audit-ready.
Compile and distribute monthly reports and data summaries for leadership.
Personify Health offers a personalized health platform combining health plan administration, wellbeing solutions, and care navigation. The company serves employers and health plans with data-driven solutions, fostering a mission-driven culture focused on improving health outcomes.
Process corporate action entitlements and related transactions accurately within established service levels.
Analyze data, resolve discrepancies, and collaborate with internal and external stakeholders to maintain service quality.
Support process improvements, training, and operational initiatives while adhering to risk controls.
A financial services operations company supporting global securities and investment activities. The company fosters a fast-paced, risk-aware environment with a collaborative culture.
Provide clear, empathetic assistance to members regarding pharmacy benefits and medication access.
Resolve complex issues by collaborating with cross-functional teams and handling sensitive cases.
Document all interactions accurately and adhere to HIPAA and privacy policies.
The OccuNet Company is an innovative company striving to reduce the cost of healthcare. They have a tight-knit culture based on outward mindset and are growing quickly.
Lead cross-functional teams for claims adjudication, benefit configuration, and production support.
Drive modernization and strategic roadmap for pharmacy claims and configuration capabilities.
Oversee client benefit plan implementation, regulatory compliance, and operational metrics.
Prime Therapeutics is a pharmacy benefit manager (PBM) focused on reimagining pharmacy solutions to simplify healthcare. The company fosters a purpose-driven, inclusive culture and is an equal opportunity employer.
Conduct high-volume outbound and inbound calls with patients, providers, and pharmacies to support medication adherence.
Collaborate with patients to identify and remove barriers to medication adherence, escalating clinical issues to pharmacists.
Document interactions and coordinate with providers and pharmacies to ensure prescription refills occur as scheduled.
Aledade PBC is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. Founded in 2014, it has become the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Manage the full lifecycle of PIP and Medical Payments claims, from coverage verification and investigation to settlement or denial.
Apply medical cost-containment strategies, coordinate experts, and identify subrogation opportunities while meeting compliance standards.
Work remotely within the US, maintaining accurate claim files and communicating professionally with claimants and stakeholders.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. The partner company is seeking a remote Associate PIP Claims Rep to handle Personal Injury Protection claims across multiple states in a structured, compliance-focused environment.