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Prior Authorization Representative

Job Description:

  • Submit initial and renewal prior authorization requests through payer portals, phone, fax, or other approved methods
  • Track open requests and follow up on time to help reduce delays in care
  • Review information for accuracy and completeness before sending requests to insurance plans
  • Work with clinicians and internal teams to gather documents needed to support authorization requests
  • Share clear updates with patients, prescribers, and team members about approvals, denials, or next steps
  • Respond to email, chat, and other requests in a timely and professional way
  • Manage daily tasks and priorities while meeting team quality and productivity goals
  • Keep patient information private and document work accurately
  • Support CarepathRx within Evernorth Health Services’ Pharmacy and Care Delivery organization, focused on specialty pharmacy and infusion services in partnership with hospitals and health systems

Requirements:

  • High school diploma or GED
  • Minimum 1 year of experience in customer service, administrative support, healthcare support, insurance, call center, data entry, or a related role
  • Basic knowledge of medical terminology
  • Comfort using computers and Microsoft Office applications, including Outlook, Word, and Excel
  • Clear written and verbal communication skills
  • Strong attention to detail and ability to stay organized while managing multiple tasks
  • Customer-focused mindset and ability to work well with patients, providers, and internal teams
  • Ability to handle confidential patient information with care
  • If working from home, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload

Benefits:

  • Annual bonus plan eligibility
  • Medical, vision, and dental benefits starting on day one
  • Well-being and behavioral health programs
  • 401(k)
  • Company-paid life insurance
  • Tuition reimbursement
  • Minimum of 18 days of paid time off per year
  • Paid holidays
  • Leaves of absence
  • Tobacco-free policy
  • Reasonable accommodation support for the online application process
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