Utilization Manager Appeals Technician (Temp to Hire)

42 minutes 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

  • Take incoming requests for first-, second-level, and external appeals.
  • Review cases to determine whether they qualify for appeal review.
  • Maintain quality, productivity, and turnaround time standards across all cases.
  • Follow internal standard operating procedures and HIPAA guidelines.
  • Update case types, send appeal acknowledgements, and submit case information to independent review organizations.
  • Communicate with appeal pharmacists regarding internal and external appeals.
  • Contact members and providers to obtain needed information for case review and document call details accurately.
  • Provide complete and accurate information to members and providers via phone and other communication channels.
  • Perform triple-check quality reviews to ensure proper handling in accordance with policies and procedures.
  • Complete 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 organization and attention to detail.
  • 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 12pm-9pm EST.
  • Experience working with commercial and Medicare appeals preferred.

Benefits

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

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

Remote Customer Support Advisor | Entry Level

Aisle and Abroad Travel & Tourism

Deidre is hiring a fully remote, entry-level Customer Support Advisor to manage client communications, organize service requests, and ensure a responsive support experience.

1 hour, 8 minutes ago

Mental Health Virtual Assistant - Patient Support & Billing Coordination

Winning Assistants Health Care Providers & Services

Remote part-time Mental Health Virtual Assistant for a private practice, handling patient phone support, onboarding, billing follow-up, and administrative coordination.

Cybersecurity HIPAA
1 hour, 42 minutes ago

Support Specialist (Overnight) / Spécialiste du soutien

Paramount Commerce 51-250 Diversified Financial Services

Paramount Commerce is hiring an overnight Support Specialist to provide customer support for its Canadian fintech payment platform, helping business customers and consumers resolve issues and maintain a smooth, secure experience.

1 hour, 43 minutes ago

Remote | Customer Representative | Cruise Specialist

Aisle and Abroad Travel & Tourism

Cruise Specialist at Deidre is an entry-level, remote customer service role focused on helping clients plan cruises, coordinate reservations, and manage booking details from start to finish.

1 hour, 56 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