Prior Authorization Analyst Sr (Remote)

Employer Industry: Pharmacy Benefit Management (PBM) Why consider this job opportunity: - Salary up to $138,000 based on experience and skills - Opportunity for career advancement and growth within the organization - Supportive and collaborative work environment - Chance to become a subject matter expert in pharmacy claims processing - Involvement in innovative projects that enhance operational efficiencies - Offers a remote work opportunity, providing flexibility in your work environment What to Expect (Job Responsibilities): - Serve as a functional subject matter expert for prior authorization input, maintenance, and issue resolution in the pharmacy claim adjudication system - Collaborate with internal partners to clarify request intent and desired outcomes for prior authorizations - Ensure quality maintenance and implementation of prior authorization loads through thorough analysis and validation - Resolve complex assignments received by the team and assist in mentoring Analyst-level colleagues - Develop, test, and deploy macros to support the Prior Authorization processes What is Required (Qualifications): - Bachelor's degree in Business Administration or a related area of study, or equivalent combination of education and relevant work experience; HS diploma or GED required - Minimum of 5 years of experience in benefits, claims, or PBM operations - Must be eligible to work in the United States without the need for work visa or residency sponsorship - Strong analytical and problem-solving skills with attention to detail - Excellent verbal and written communication skills How to Stand Out (Preferred Qualifications): - Previous experience with Medicare or Medicaid - Experience performing data analysis and validation - Strong desire to be a subject matter expert in pharmacy claims processing - High proficiency in RxClaim, Microsoft Office products, and other analytical tools - Experience working on cross-functional projects #PharmacyBenefitManagement #RemoteWork #CareerGrowth #CompetitiveSalary #HealthcareCareers "We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer." Apply tot his job Apply To this Job