Job Description

Responsibilities:

• Ensure timely review of ePAR and PBM cases and process as per prescribed guidelines and protocols.
• Responsible for issuing accurate Pre-approvals to the providers and deliver excellent customer service.
• Review pre-approval request and adjudicate as per defined policy terms and conditions/clinical/regulatory guidelines.
• Answer calls and emails from pharmacies, providers, and customers using exemplary customer service skills.
• Review clinical data matching it against specified medical terms and/or diagnosis/procedure codes and follow established procedure for authorizing preapproval request.
• Establish effective rapport with other employees and supervisor and maintain cooperative working relationship; actively support departmental activities.

Qualifications:

• Bachelor’s degree in any medical field and/or specialization.
• at least 1-year related professional working experience.
• Strong communication and interpersonal skills.

Additional information:

• We are operating 24×7, on a shifting schedule; whole shift you will be attending to calls.
• Weekdays off