Appeals Technician – Temp-to-Hire

This is a fully remote position, open to applicants in New York.

📋 Description

• Accountable for managing incoming requests for first, second level, and external appeals, while ensuring a high standard of customer service and optimizing productivity.

• Collaborate with the appeals team across various lines of business, including Commercial, Exchange, and Medicare, to ensure the accurate submission of appeals for evaluation by pharmacists and medical directors.

• Maintain quality and productivity benchmarks for all reviewed cases while fulfilling established turnaround time expectations.

• Stay informed on all communications and updated processes conveyed through multiple channels and apply this knowledge to daily tasks.

• Comply with all internal Standard Operating Procedures and adhere to HIPAA regulations and policies.

• Examine all received cases to confirm they meet the qualifications for appeal review.

• Conduct a triple-check to guarantee quality reviews and handling in line with policies and procedures.

• Update case types, send appeal acknowledgments, and relay case information to independent review organizations.

• Communicate effectively with appeal pharmacists regarding both internal and external appeals.

• Make verbal outreach efforts to gather necessary information for case review and document accurate details obtained during calls.

• Demonstrate exceptional phone and communication skills while providing comprehensive and accurate information to members and providers.

• Carry out all other related duties as assigned.

⛳️ Requirements

• Minimum of 1 year of experience as a certified pharmacy technician in a managed care or PBM environment is required.

• Active, unrestricted PTCB or NHA Certified Pharmacy Technician certification is mandatory.

• Strong attention to detail and excellent organizational skills.

• Proficient oral and written communication abilities.

• Capability to work independently with little supervision, maintain productivity in a remote, high-volume, metric-driven setting with changing priorities.

• Availability to work from 12 PM to 9 PM EST.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible work hours

• Paid time off

• Remote work options