Appeals Technician (Temp to Hire)

2 weeks, 4 days ago
Full-time
Junior
Customer and Technical Support
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017

Description

  • Process incoming first-, second-level, and external appeals with a high level of customer service and productivity.
  • Review cases to determine whether they qualify for appeal review.
  • Maintain quality standards, productivity expectations, and turnaround time requirements for all reviewed cases.
  • Follow internal standard operating procedures and comply with HIPAA guidelines and policies.
  • Perform triple checks to ensure accurate quality reviews and proper handling of cases.
  • Update case types, send appeal acknowledgements, and submit case information to independent review organizations.
  • Communicate with appeal pharmacists regarding internal and external appeals.
  • Make outreach attempts to obtain needed information for case review and document information accurately.
  • Provide complete and accurate information to members and providers by phone and written communication.
  • Perform other related duties as assigned.

Requirements

  • 1+ years of experience as a certified pharmacy technician in a managed care or PBM setting.
  • Active, unrestricted certified pharmacy technician license.
  • Strong organizational skills and detail orientation.
  • Strong oral and written communication skills.
  • Ability to work independently with minimal supervision in a remote, high-volume, metric-driven environment with shifting priorities.
  • Ability to work 12:00pm-9:00pm EST.
  • Experience working with commercial and Medicare appeals (preferred).

Benefits

  • Remote work opportunity in the US.
  • Base salary range of $60,000-$65,000 USD for remote US roles.
  • Base salary range of $78,800-$98,500 USD for New York, NY.
  • Base salary range of $72,000-$90,000 USD for Denver, CO.

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

Customer Service – Booking Hotels | Entry Level

Aisle and Abroad Travel & Tourism

Deidre is hiring an entry-level remote customer service representative to support hotel bookings and reservation services for clients in the travel and hospitality space.

35 minutes ago

Online | Customer Care Coordinator | Entry level

Aisle and Abroad Travel & Tourism

Deidre is hiring a fully remote Customer Care Coordinator in Atlanta to manage client communications, support coordination tasks, and ensure a smooth customer experience.

1 hour, 55 minutes ago

Student Care Representative

ELVTR 51-250 Diversified Consumer Services

ELVTR is hiring a remote Student Care Representative in Ukraine to support students enrolled in its live online courses and ensure a smooth, satisfying learning experience.

Asana CRM HubSpot
2 hours, 2 minutes ago

Remote - Customer Service – Booking Specialist

Aisle and Abroad Travel & Tourism

Remote Customer Service Representative – Travel Booking at a trusted travel planning company, helping clients research, plan, and secure hotel and cruise bookings while delivering responsive, personalized service.

2 hours, 9 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers