Utilization Management Appeals Technician – Temp-to-Hire

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

📋 Description

• Accountable for handling incoming requests related to first, second-level, and external appeals while ensuring exceptional customer service and maximizing efficiency.

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

• Uphold quality and productivity standards for all reviewed cases while adhering to established turnaround time requirements.

• Stay updated on all communications and revised processes conveyed through various channels and integrate them into daily tasks.

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

• Review all incoming cases to confirm if they qualify for appeal review.

• Conduct a thorough triple check to guarantee quality reviews and handling in accordance with established policies and procedures.

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

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

• Make verbal outreach attempts to gather necessary information for case review and accurately document the information obtained during calls.

• Demonstrate excellent phone and communication skills while providing complete and precise information to members and providers.

• Perform all other related duties as assigned.

⛳️ Requirements

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

• Active and unrestricted PTCB or NHA Certified Pharmacy Technician certification is necessary.

• Exceptional organizational skills and a keen attention to detail.

• Strong oral and written communication abilities.

• Capability to work independently with minimal supervision, remaining productive in a remote, high-volume, metrics-driven setting with changing priorities.

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

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and growth.

• Flexible work environment and schedule.

• Supportive team atmosphere with a focus on collaboration and success.