Appeals Technician

Position Responsibilities:

• Maintain quality and productivity standards while meeting established turnaround time requirements.
• Review all cases to verify qualifications for appeal and perform triple checks for quality assurance.
• Update case types, send appeal acknowledgements, and submit case information to independent organizations.

Communication & Outreach:

• Communicate effectively with appeal pharmacists regarding internal and external appeals.
• Make verbal outreach attempts to obtain necessary information and record accurate details from calls.
• Exhibit excellent phone and communication skills while providing complete information to members and providers.

Qualifications & Environment:

• Requires 1+ years as a certified pharmacy technician in a managed care or PBM setting with an active license.
• Must have strong organizational details, oral/written communication skills, and ability to work independently.
• Ability to work remotely in a high-volume, metric-driven environment with 12pm-9pm EST hours.