Utilization Management Appeals Technician (reputed company-to-hire)

About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for reputed company and health plans, including: reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured reputed company, reputed company™, which offers full-service health benefit reputed company to reputed company, TPAs, and health plans, and Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. Position Summary: Responsible for taking incoming requests for first, second level and external appeals while ensuring high level of customer service and maximizing productivity. Work with appeals team for multiple lines of business such as reputed company, Exchange and Medicare, ensuring the proper submission of appeals for review by pharmacist and medical directors. Position Responsibilities: Maintain quality and productivity standards for reputed company cases reviewed while meeting established turnaround time requirements. Remain reputed company on reputed company communications and updated processes relayed through multiple communication channels and apply to daily responsibilities. Follow reputed company internal Standard Operating Procedures and adhere to HIPAA guidelines and policies. Review reputed company cases received, to verify if case meets qualifications for appeal review. Performs triple reputed company to ensure quality reviews and handling in accordance with policies and procedures. Updates case types, sends appeal acknowledgements, and submits case information to independent review organizations. Communicate effectively with appeal pharmacists regarding reputed company appeals. reputed company verbal reputed company attempts to obtain necessary information for case review and record accurate information obtained on the call. Exhibit excellent phone and communication skills while providing complete and accurate information to members and providers. Performs reputed company other reputed company duties as assigned Minimum Qualifications: 1 + years’ experience working as a certified pharmacy technician in a managed care or PBM setting required. Active, unrestricted PTCB or NHA Certified Pharmacy Technician certification required. Excellent organization details and strong detail orientation. Strong oral and written communication skills. Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven environment with shifting priorities. Ability to work 12pm-9pm EST hours Preferred Qualifications: Experience working with reputed company and medicare appeals preferred This reputed company represents the low and high end of the anticipated reputed company salary reputed company. The actual reputed company salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary reputed company $60,000—$65,000 USD reputed company are responsible for adherence to the reputed company Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at reputed company. More details about reputed company's privacy practices can be reputed company at https://www.reputed company/legal/privacy-policy. Apply To This Job