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Added 6 mins ago
TS
IT Asset Management Analyst
The Salvation Army in Canada
Toronto, ON · Greater Toronto Area, Canada
- Contract
The Salvation Army exists to share the love of Jesus Christ, meet human needs and be a transforming influence in the communities of our world.
Added 6 mins ago
JG
Group Marketing & Renewal Analyst
Johnston Group Inc.
Winnipeg, MB
- Full-time
Execute marketing and renewal activities on behalf of our partner advisors.
Added 6 mins ago
TS
IT Asset Management Analyst
The Salvation Army in Canada
Toronto, ON
- Contract
The Salvation Army exists to share the love of Jesus Christ, meet human needs and be a transforming influence in the communities of our world.
Added 6 mins ago
PG
Senior Designer, Social
Publicis Groupe Canada
Toronto, ON · Greater Toronto Area, Canada
- $85,000 to $90,000 CAD / year
- Full-time
Partner closely with creative, strategy, account, media, production, community, and
Added 6 mins ago
B&
Retail Store Manager-CARREFOUR DE LA RIVE-SUD
Bath & Body Works
Boucherville, QC
- $62,800 to $81,640 USD / year
- Full-time
Partner with the SLT to support action plans that improve results and ensure effective execution of operational activities.
Added 8 mins ago
CQ
Marketing & Campaign Specialist
Canadian Queer Chamber of Commerce (CQCC)
Toronto, ON
- $60,000 to $65,000 CAD / year
- Full-time
Established in 2003, the Canadian Queer Chamber of Commerce is a trusted partner linking 2SLGBTQI+ businesses in Canada to the wider business community. The CQCC fosters economic growth by…
Added 8 mins ago
A
Talent Acquisition Partner
Altis
Brampton, ON
- $70,000 to $90,000 CAD / year
- Full-time
Bachelor's degree in Human Resources, Business, or a related field
Added 8 mins ago
LS
Key Account Manager
Lock Search Group
Toronto, ON · Greater Toronto Area, Canada
- Full-time
As a strategic partner to both customers and internal stakeholders, the KAM collaborates closely with Medical Affairs, Market Access and Commercial teams to coordinate resources, address…
Added 8 mins ago
B
Senior Manager, Marketing and Commercial Operations
BD
Mississauga, ON
- Full-time
…Waters’ passionate team of approximately 16,000 colleagues partner with customers to turn scientific challenges into breakthroughs that improve lives…
Added 8 mins ago
MR
Director, Total Rewards
Meridia Recruitment Solutions, a KBRS Company
Saint John, NB
- Full-time
Collaborate with the Vice President of Human Resources to identify, create, design and evolve our company wide Total Rewards programs;
Added 9 mins ago
Supervisor, Income
Questrade Financial Group
Toronto, ON
At QFG, we combine human-centric collaboration with AI-driven innovation to redefine financial services. The ideal candidate will be a catalyst for change, using AI to transform and deliver…
Added 9 mins ago
Learning & Development Coordinator
Manitoba Blue Cross
Winnipeg, MB
Minimum 1 year of experience in an administrative, coordination, or support role, preferably within Learning & Development, Human Resources, or Training.
Added 24 mins ago
O
Manager, Global Wellbeing
OMERS
Toronto, ON · Head Office Toronto
- Full-time
University degree or diploma in health, social sciences, human resources, or a related discipline.
Added 24 mins ago
O
Director HR Systems & Payroll
OLG
Sault Ste. Marie, ON · Toronto, ON · York Mills Office
- Full-time
University degree in Information Technology, Data/Business Analytics, Human Resources, Business Management, Accounting or a related field. Post-Graduate/ Masters degree in a relevant field…
Added 24 mins ago
O
Director IT Business Management
OLG
Sault Ste. Marie, ON · Toronto, ON · Foster Drive Office
- Full-time
…trusted advisor to the CTIO and EIT Senior Leadership and a key partner to Finance and…
Added 37 mins ago
N(
Enterprise Data Systems Analyst
NAIT (Northern Alberta Institute of Technology)
AB · Edmonton, AB
- Full-time
The Enterprise Data Systems Analyst is an intermediate-level IT position responsible for supporting the effective operation of technology resources.
Added 37 mins ago
G
Benefits Producer
Gallagher
Toronto, ON
- $120,000 to $170,000 USD / year
- Full-time
At Gallagher Benefit Services, you’re a trusted partner to organizations navigating some of their most important people decisions. We help clients build better workplaces, where people feel…
Added 37 mins ago
A
Senior Manager, Change Management & Organizational Development
Aplin
Mississauga, ON
- Full-time
Bachelor's degree in Human Resources, Organizational Development, Business, Psychology or a related discipline. Advanced degree or change management certification is an asset.
Added 37 mins ago
S-
Talent Acquisition Specialist
SPE - Serruya Private Equity
Markham, ON
- Full-time
Post-secondary education in Human Resources, Business Administration, or a related field preferred.
Added 39 mins ago
T
Manager, Models & AI Governance
TD
Toronto, ON
- Full-time
…accountability, data usage, model performance, and appropriate human…
Added 39 mins ago
C
Manager, Change & Continuous Improvement
Co-op
Saskatoon, SK
- Full-time
…including marketing, market research, information technology, human resources, accounting, risk management and business…
Added 39 mins ago
SL
Executive Compensation Consultant
Sun Life
Toronto, ON · Sun Life Toronto One York
- Full-time
Participate in senior management / business partner discussions regarding initiatives/changes in organization structures and compensation programs
Added 39 mins ago
D
Senior Manager, HR Technology & Delivery
dentalcorp
Toronto, ON · Support Centre - Toronto Office
- Full-time
Post-secondary education in Human Resources, Information Systems, Information Technology, Business Administration, or a related discipline, or equivalent experience is required.
Added 39 mins ago
C
Senior Talent Acquisition Partner
CIBC
Vancouver, BC
- Full-time
As a member of the Human Resources Talent Acquisition team, you'll proactively source and assess best-in-class external talent, helping us hire team members who can deliver an exceptional…
Added 39 mins ago
BG
Payroll Manager
Boyd Group Services
Winnipeg, MB
- Full-time
Monitor regulatory developments, assess payroll impacts, and partner with Legal, HR, Tax, Compensation, and Operations to implement required changes and mitigate compliance risk.

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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