Prior Authorizations Technician I

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

📋 Description

• Handle incoming calls from providers, pharmacies, members, and other callers throughout the criteria-based prior authorization process.

• Offer professional and courteous assistance over the phone.

• Ensure thorough, timely, and accurate documentation of reviews is maintained.

• Forward clinical inquiries, escalations, and judgment calls to the pharmacist team.

• Initiate outbound calls as required.

• Review and process prior authorizations received via fax and electronic prior authorization (ePA).

• Monitor and address inquiries in the department mailbox.

• Manage incoming calls, fax requests, and ePA requests in accordance with established protocols.

• Communicate determination statuses and results with internal teams, including seniors, pharmacists, and appeals.

• Recognize and escalate clinical inquiries to the pharmacist team.

• Conduct faxing, sorting, email management, CAS maintenance, and other assigned tasks.

⛳️ Requirements

• A minimum of 6 months of experience in customer service or as a pharmacy technician.

• High school diploma or equivalent GED.

• Basic computer proficiency.

• Familiarity with Microsoft Office Suite, including Excel and Word; knowledge of Access, Outlook, PowerPoint, and Visio is a plus.

• Essential keyboarding skills.

• Capability to multitask and utilize multiple system applications concurrently.

• Basic understanding of pharmaceutical terminology, calculations, and protocols.

• Ability to independently utilize available resources and produce high-quality work.

• Capacity to absorb information, show motivation, pursue development, and resolve issues.

• Flexibility to adapt to changes in workflow and shifting priorities.

• Excellent written, verbal, grammatical, and listening communication skills.

• Competence in interacting with a diverse range of internal and external customers in a friendly and confident manner.

• Ability to maintain the confidentiality of Protected Healthcare Information (PHI).

• Regular and predictable attendance is required.

• Willingness to work mandatory overtime or extended work weeks as necessary.

• Openness to travel when required.

• Ability to adhere to departmental, company, state, and federal regulations.

• Capacity to work long periods while sitting, engaging in phone conversations, and reading from a computer screen.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Comprehensive benefits package for full-time employees, based on eligibility.