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Added 10 mins ago
AW
Gestionnaire de comptes bilingue/ Bilingual Account Manager
Agilus Work Solutions
Montreal, QC
- $60,000 to $70,000 CAD / year
- Full-time
Agilus by Synergie is recruiting for a Bilingual Account Manager - Technology in the Staffing Services Sector in a hybrid work environment in Montreal, Quebec.
Added 10 mins ago
FS
Senior Manager, Project Management Office
Financial Services Regulatory Authority of Ontario (FSRA)
Toronto, ON
- Full-time
Conducts operational planning, development and reporting on PMO’s performance metrics, program effectiveness, risks and impacts related to unit, section and department matters. Recommends…
Added 10 mins ago
MT
Health And Safety Coordinator
MT Talent Solutions Inc.
Richmond Hill, ON
- $65,000 to $75,000 CAD / year
- Full-time
…industrial manufacturing environment. Working closely with the HR Manager and operational leadership, you will have a highly visible, hands-on presence on the plant floor and play an…
Added 11 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 11 mins ago
Licensed Practical Nurse (LPN) - N3E-Medicine - Repost
Winnipeg Regional Health Authority
Winnipeg, MB
Under the general supervision of the Manager Health Services, the Licensed Practical Nurse (LPN) is responsible for providing professional practical nursing services to designated patients,…
Added 11 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 11 mins ago
A
Gestionnaire de projet en ingénierie / Project Manager, Engineering
Airbus
Montreal, QC · Mirabel, QC
- Full-time
Added 11 mins ago
Cook (73% P/T) - NS Youth Centre
The Government of Nova Scotia
NS · WATERVILLE, NS
Under the supervision of the Kitchen Manager, the Cook is responsible for food preparation and the delivery of food services to young persons, staff, patients and visitors of the…
Added 11 mins ago
JG
Sales Manager
Jacuzzi Group
Remote, Canada
- Full-time
- Remote
Jacuzzi Group is seeking a Sales Manager to drive sales growth within an assigned territory. This role manages a network of dealers while identifying and developing new market opportunities…
Added 11 mins ago
JG
Sales Manager
Jacuzzi Group
Remote, Canada
- Full-time
- Remote
Jacuzzi Group is seeking a Sales Manager to drive sales growth within an assigned territory. This role manages a network of dealers while identifying and developing new market opportunities…
Added 11 mins ago
JG
Sales Manager
Jacuzzi Group
Remote, Canada
- Full-time
- Remote
Jacuzzi Group is seeking a Sales Manager to drive sales growth within an assigned territory. This role manages a network of dealers while identifying and developing new market opportunities…
Added 11 mins ago
JG
Sales Manager
Jacuzzi Group
Remote, Canada
- Full-time
- Remote
Jacuzzi Group is seeking a Sales Manager to drive sales growth within an assigned territory. This role manages a network of dealers while identifying and developing new market opportunities…
Added 11 mins ago
JG
Sales Manager
Jacuzzi Group
Remote, Canada
- Full-time
- Remote
Jacuzzi Group is seeking a Sales Manager to drive sales growth within an assigned territory. This role manages a network of dealers while identifying and developing new market opportunities…
Added 11 mins ago
Line Cook - Temp, Granville Island Brewing
Molson Coors
Vancouver, BC
Reporting to the Taproom Manager, it is expected that all kitchen staff take responsibility for setting the expectation for other team members to work as a team to maximize our…
Added 11 mins ago
Licensed Practical Nurse, Garron Centre
Nova Scotia Health and IWK Health
Halifax, NS
Accountable to the Clinical Manager, Garron Centre for Child & Adolescent Mental Health, the Licensed Practical Nurse (LPN) is a member of the clinical care team, collaborating in the…
Added 11 mins ago
S
Services Lead, Stores - Full Time
Sephora
Winnipeg, MB
- $20.8 to $24.45 CAD / hour
- Full-time
…performance-based bonus opportunities, a competitive benefits program, and robust learning and development initiatives aimed at promoting employee support and…
Added 11 mins ago
N3
Warehouse Trainer
NRI 3PL
Surrey, BC
- Full-time
…experience, best practices, safety, and SOP complaint aid in the development of the training program. The Trainer is to be a mentor to all new employees and helps create and demonstrate NRI…
Added 11 mins ago
N3
Warehouse Trainer
NRI 3PL
Surrey, BC
- Full-time
…experience, best practices, safety, and SOP complaint aid in the development of the training program. The Trainer is to be a mentor to all new employees and helps create and demonstrate NRI…
Added 25 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 25 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 25 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 25 mins ago
HH
PRO Marketing Specialist
Home Hardware Stores Limited
St. Jacobs, ON
- Full-time
…Home’s overall PRO Marketing efforts. Led by the PRO Marketing Manager, this opportunity will best suit someone who has strong marketing, organizational and communication…
Added 25 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 25 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 25 mins ago
F
Commerce Specialist
Flywheel
Toronto, ON
- Full-time
The Commerce Specialist role offers the unique opportunity to join a program where you build your skillsets in both media and retail capabilities, to ensure a well-rounded Commerce…

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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