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Added 3 mins ago
Billing Analyst
Metso
Sudbury, ON · Burlington, ON · Montreal, QC · Prince George, BC · Wabush, NL
We are looking for a Project Coordinator to join our Project Delivery & Services team. In this role, you will support the planning, execution, and successful delivery of customer projects…
Added 3 mins ago
HR Generalist (12-18 Month Limited Term)
Energy Safety Canada
Calgary, AB
Reporting to the Manager, the Human Resources (HR) Generalist will provide guidance and support on all HR related matters to ESC employees. The Generalist will lead and/or support all…
Added 16 mins ago
FM
Meat Cutter (NOC 65202)
Fresh Market Foods
Sioux Lookout, ON
- Full-time
Respond to customer inquiries and provide product information to support a positive customer experience
Added 16 mins ago
FM
Baker (NOC 63202)
Fresh Market Foods
Sioux Lookout, ON
- Full-time
Assist with merchandising, displays, and product promotions to support bakery sales.
Added 16 mins ago
FS
Senior Manager, Project Management Office
Financial Services Regulatory Authority of Ontario (FSRA)
Toronto, ON
- Full-time
…concurrent project initiatives involving both core regulatory and support areas across FSRA. Ensures consistency with overall section performance measures, standards and best practices and…
Added 16 mins ago
M
Billing Analyst
Metso
Montreal, QC
- Full-time
We are looking for a Project Coordinator to join our Project Delivery & Services team. In this role, you will support the planning, execution, and successful delivery of customer projects…
Added 17 mins ago
Education & Engagement Consultant
The Canada Life Assurance Company
Hamilton, ON · London, ON · Toronto, ON
Reporting to the National Manager, Education & Engagement, you will be responsible for facilitating group retirement education session(s) and developing education and communication…
Added 17 mins ago
H
Nurse B - Clinician
HealthCareersInSask.ca
Saskatoon, SK
- Full-time
Job Description: Reporting to the manager of the COPD program, the nurse clinician: has primary clinical responsibility for the COPD program. Utilizes established criteria to assess and…
Added 17 mins ago
E
Resident Programs Manager - Red River Place - Full-Time
Extendicare
Selkirk, MB · LTC - Red River Place (Manchester Ave.)
- Full-time
Lend a Helping Hand- to promote and support community engagement opportunities,
Added 32 mins ago
S
CORE HCM Lead, BC Health Workday
Sanya’k̓ula
BC · British Columbia, Canada
- Full-time
Reporting to the Manager, CORE HCM & Recruitment, the CORE HCM Lead is responsible for providing leadership within their assigned functional area for implementation of the new BC Health…
Added 32 mins ago
BC
Registered Practical Nurse - Emergency Department
Brant Community Healthcare System
Brantford, ON
- Full-time
Investing in You – Access to a centralized Education Fund, tuition support, and professional development opportunities.
Added 32 mins ago
BC
Registered Practical Nurse - Emergency Department
Brant Community Healthcare System
Brantford, ON
- Full-time
Investing in You – Access to a centralized Education Fund, tuition support, and professional development opportunities.
Added 32 mins ago
1
Office Manager - Ottawa, ON - 12727
123Dentist
Toronto, ON
- Full-time
The team located in Ottawa, ON are looking for a passionate, hard-working Office Manager on a full-time basis.
Added 32 mins ago
ST
Coordinator, Exam Planning
Skilled Trades Ontario / Métiers spécialisés Ontario
Mississauga, ON
- $30.75 to $38.99 CAD / hour
- Full-time
Administering apprenticeship programs, including approving apprentices and sponsors, registering training agreements and assessing applications for apprenticeship program completion.
Added 32 mins ago
SG
Assurance - Senior Associate
Segal GCSE LLP
Toronto, ON · North York, ON
- $70,000 to $100,000 CAD / year
- Full-time
In consultation with the engagement manager plans, organizes, and controls multiple responsibilities and resources to achieve Audit, Review and Notice to Reader engagement objectives.
Added 32 mins ago
TP
Senior Representative, Passenger Care (Term Opportunity - One Year)
Toronto Pearson International Airport
Toronto, ON
- Temporary
Reporting to the Manager, Passenger Care, this role leads the development, implementation, and continuous improvement of accessibility and passenger care programs across Toronto Pearson…
Added 33 mins ago
P
Senior Customer Success Manager
Procurify
Remote, Canada
- Full-time
- Remote
Community initiatives: We have a strong commitment to giving back to our communities, including regular volunteer days, our Donate Your Day program, and education lunch and learns.
Added 33 mins ago
E
Program Manager
Equus
Bath, ON · Loyalist Township/Bath, Ontario
- $32.5 CAD / hour
- Full-time
The Program Manager reports to the Project Director for a given region and provides leadership through planning, implementing, coordinating, and evaluating Agilec sites/projects to ensure…
Added 47 mins ago
FR
Condominium Manager
FirstService Residential Canada
Toronto, ON
- Full-time
The Property Manager will perform functions ensure properties are maintained and operated in accordance with company objectives and facilitate solutions to problems between communities and…
Added 47 mins ago
FB
Assistant Chef Manager
Farm Boy Inc.
Brantford, ON
- $21 CAD / hour
- Full-time
You’ll partner with the Department Manager to help lead the delivery of exceptional food and service experiences that reflect Farm Boy’s commitment to the best fresh shopping experience.…
Added 47 mins ago
CO
Swim Instructor & Lifeguard
City of Brampton
Brampton, ON
- Temporary
…are responsible to plan, organize and deliver high quality program that is engaging and enjoyable for all participants. Supervise and maintain a safe, enjoyable environment for all…
Added 47 mins ago
FC
Part-Time Professor, Electrical Techniques St. Thomas/Elgin Regional Campus
Fanshawe College
St. Thomas, ON
- Part-time
Collaborate with faculty colleagues, program leadership, and campus staff to support program quality and student achievement
Added 47 mins ago
SH
Unit Clerk - Repost
Shared Health-Soins Communs
Winnipeg, MB
- Full-time
Under the general supervision of the Manager Health Services and a Registered Nurse (RN) or Registered Psychiatric Nurse (RPN), and while demonstrating a commitment to the Mission, Values…
Added 48 mins ago
CT
Regional Manager - North East
CAREERS: The Next Generation
Fort McMurray, AB
- Full-time
Reporting to the Director, Operations, the Regional Manager is responsible for implementing the organization’s strategic goals, mission, vision and values into operational plans, and for…
Added 48 mins ago
Produce Utility Clerk (Shawnessy)
Calgary Co-operative Association Limited
Calgary, AB
…position reports directly to the Produce Supervisor/Produce Manager, and the main responsibilities…

Jobgether

Case Manager – Drug Prior Authorization

Canada

$43,875 to $73,125 CAD / year · Full-time

Apply About employer

Applications open in a new tab.

Job details

Pay: $43,875 to $73,125 CAD / year
Job type: Full-time
Experience: 2–3 years of experience in a customer service, case management, claims processing, or related environment.
Posting language: English
Posted: Oct 5, 2026

Original job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Case Manager – Drug Prior Authorization based in Canada.

This role plays a key part in managing complex drug prior authorization requests and claims requiring specialized handling.

You will own cases end to end, assessing submissions against clinical guidelines, plan provisions, and established approval criteria.

You will also manage sensitive, escalated, non-standard, and high-value cases that require sound judgment and in-depth analysis.

The role involves regular communication with plan participants, healthcare providers, pharmacies, and internal stakeholders.

You will serve as a subject matter expert on prior authorization and claims adjudication, while supporting knowledge sharing and colleague training.

Your expertise will directly contribute to service quality, customer satisfaction, operational efficiency, and continuous improvement.

You will work in a dynamic, flexible, and collaborative environment that values professional development, sound decision-making, and operational excellence.

Accountabilities

Receive, analyze, and adjudicate drug prior authorization requests according to applicable clinical guidelines, plan provisions, and approval criteria.
Manage cases from initial receipt through resolution, prioritizing work according to urgency and complexity.
Investigate complex, non-standard, or escalated cases and conduct the necessary research to determine appropriate actions.
Review high-value claims and situations requiring additional analysis or specialized attention.
Clearly communicate claims decisions to plan participants, healthcare providers, pharmacies, and internal stakeholders while meeting established service standards and processing timelines.
Act as a subject matter expert on prior authorization and claims adjudication, providing guidance and support to internal teams and outsourced partners.
Apply risk-management principles and sound professional judgment when evaluating requests and resolving cases.
Manage escalated cases and contribute to their timely, accurate, and customer-focused resolution.
Participate in projects and initiatives designed to improve operational efficiency, quality, processes, and customer experience.
Contribute to quality assurance, training, mentoring, knowledge-sharing, and continuous improvement activities.
Support objectives related to customer satisfaction, financial efficiency, and broader strategic priorities.
Maintain accurate case documentation and protect confidential customer and organizational information.

Requirements

Postsecondary education or an equivalent combination of relevant education and experience.
2–3 years of experience in a customer service, case management, claims processing, or related environment.
Experience in group benefits, claims administration, disability, insurance, or another regulated environment.
Knowledge of benefits plan administration and medical and dental terminology or claims processes.
Proficiency with Microsoft Office 365 applications.
Experience analyzing complex cases, assessing risk, and resolving sensitive or challenging situations.
Excellent written and verbal communication skills, with the ability to interact effectively with a broad range of stakeholders.
Strong analytical, problem-solving, decision-making, and professional judgment skills.
Ability to manage multiple priorities in a dynamic and continuously changing environment.
Strong attention to detail and a high level of commitment to accuracy and confidentiality.
Ability to work independently while collaborating effectively with a multidisciplinary team.
Strong customer focus and the ability to build positive, professional relationships with stakeholders.
Strong influencing, negotiation, collaboration, and communication skills.
Adaptability when faced with process changes, new technologies, and competing priorities.
A proactive approach focused on continuous improvement, operational excellence, and solution finding.
Experience as a subject matter expert, mentor, or informal team leader is an asset.

Benefits

Indicative annual salary range of CAD $43,875–$73,125, depending on location, qualifications, skills, experience, and role requirements.
Eligibility for incentive programs and performance-based compensation tied to individual and organizational results.
WorkSmart flexible working arrangement.
Opportunities to work from locations including Waterloo, Toronto, Kitchener, Halifax, and Montreal.
Medical and dental coverage.
Mental health and vision care coverage.
Short- and long-term disability insurance and life insurance.
Accidental death and dismemberment insurance.
Employee and family assistance programs.
Retirement savings plans, including options with employer matching contributions.
International employee share ownership program with employer contributions, subject to eligibility.
Financial education and advisory resources.
Paid time off including statutory holidays, vacation, personal days, and sick leave.
Learning, professional development, and career growth opportunities.
Flexible and inclusive work environment focused on employee well-being, collaboration, and diversity.
Opportunities to contribute to continuous improvement initiatives and projects that positively impact the customer experience.

How Jobgether Works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Apply About employer

More about this job

Responsibilities

Manage drug prior authorization requests and claims from intake through resolution, applying clinical guidelines, plan provisions, and approval criteria while handling complex, escalated, and high-value cases. Communicate decisions to participants and stakeholders, provide subject matter expertise and colleague support, maintain accurate confidential records, and contribute to quality, training, and operational improvement initiatives.

Requirements

Requires postsecondary education or an equivalent combination of education and experience, along with 2–3 years in customer service, case management, claims processing, or a related environment. Candidates should have relevant benefits, insurance, or regulated-environment experience; strong analytical, communication, judgment, and organizational skills; Microsoft Office 365 proficiency; and the ability to manage sensitive cases accurately and confidentially.

Skills

Drug Prior Authorization
Claims Adjudication
Case Management
Complex Case Analysis
Risk Assessment
Decision-Making
Customer Service
Stakeholder Communication
Benefits Plan Administration
Medical and Dental Terminology
Microsoft Office 365
Problem-Solving
Negotiation
Quality Assurance
Training and Mentoring
Confidentiality

Benefits

Incentive Programs
Flexible Working Arrangement
Medical Coverage
Dental Coverage
Mental Health Coverage
Vision Care Coverage
Short-Term Disability Insurance
Long-Term Disability Insurance
Life Insurance
Accidental Death and Dismemberment Insurance
Employee and Family Assistance Programs
Retirement Savings Plans
Employer Matching Contributions
Employee Share Ownership Program
Financial Education and Advisory Resources
Paid Time Off
Professional Development and Career Growth

Visa sponsorship

Not detected in the job text

Keywords

Drug Prior Authorization
Claims Processing
Claims Adjudication
Clinical Guidelines
Benefits Plan Administration
Approval Criteria
Case Management
Complex Case Analysis
High-Value Claims
Risk Management
Customer Service
Stakeholder Communication
Medical Terminology
Dental Terminology
Group Benefits
Claims Administration
Insurance
Microsoft Office 365
Quality Assurance
Training
Mentoring
Knowledge Sharing
Continuous Improvement
Confidentiality
Operational Efficiency

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