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Added 13 mins ago
TH
Paint Sales Associate: Part Time - KAMLOOPS
The Home Depot Canada
Kamloops, BC
- Part-time
Using empowerment program when necessary to satisfy customers
Added 43 mins ago
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Automation Project Manager
Boccard
Montreal, QC
- Full-time
The Automation Project Manager is responsible for overseeing the successful execution of automation projects, with a primary focus on the Electrical, Industrial IT, and Automation (EIA)…
Added 43 mins ago
SP
Tour Sales Coordinator
Sun Peaks Grand Hotel & Conference Centre
BC · Sun Peaks Mountain, BC
- Full-time
…a meaningful impact on our guests’ experiences while being part of a collaborative team. If this sounds like your ideal work environment, please consider applying…
Added 43 mins ago
AS
EVENTS MANAGER - NFP, CORPORATE EVENTS
Australasian Society of Association Executives
Burlington, ON
- Contract
If you're an experienced corporate Events Manager with EventsAIR experience who takes pride in delivering high-quality events, this is a great opportunity to join a collaborative team and…
Added 43 mins ago
LC
Certification Assistant – Delta
LabTest Certification Inc.
Delta, BC
- $21 to $24 CAD / hour
- Full-time
It is an exciting time to be a part of our growing team.
Added 43 mins ago
LC
Administrative Assistant – Delta
LabTest Certification Inc.
Delta, BC
- $21 to $24 CAD / hour
- Full-time
It is an exciting time to be a part of our growing team.
Added 43 mins ago
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Software Developer - Networking (Flow)
Nutanix
Vancouver, BC
- $103,000 to $155,000 CAD / year
- Full-time
…(as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance,…
Added 43 mins ago
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Principal Network Engineer
Aviso
Vancouver, BC
- $135,000 to $145,000 CAD / year
- Full-time
…This is a hands-on, high ownership role that will play a key part in evolving our Azure-native networking capabilities while maintaining a secure and resilient hybrid network…
Added 43 mins ago
TO
Public Works Foreman
Town of Peace River
Peace River, AB
- Full-time
Reporting to the Public Works Manager, this is a hands-on leadership position for someone who enjoys being out in the field, solving problems, supporting employees, and making sure the job…
Added 43 mins ago
TO
Labourer 1
Town of Peace River
Peace River, AB
- Full-time
The Town of Peace River is accepting applications for one (1) permanent, full-time Labourer within the Public Works Department. Reporting to the Public Works Foreman, this position plays an…
Added 43 mins ago
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Warehouse Operator - Part-Time - Saanich
Buckerfield's
Saanich, BC
- Part-time
Buckerfield's Saanich – Part Time Warehouse Operator – Starting Rate: $19.00 - 20.00 / hour - Weekend Availability Required
Added 43 mins ago
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Senior Software Developer - Networking (Flow)
Nutanix
Vancouver, BC
- $151,000 to $227,000 CAD / year
- Full-time
…(as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance,…
Added 43 mins ago
OI
Hospitality Management Instructor
Oxford International
Vancouver, BC
- $35 CAD / hour
- Part-time
Oxford International Career College is seeking a part-time Hospitality Management Instructor for our Vancouver campus.
Added 1 hour ago
DB
Part Time Bridal Sales
David's Bridal
Dartmouth, NS
- $16 to $22.32 CAD / hour
- Part-time
…presentation and operations of the store. S/he reports to the Store Manager in partnership with the Sales Manager. Bridal Stylists are brand ambassadors and demonstrate the values and…
Added 1 hour ago
DB
Part Time Bridal Sales
David's Bridal
Woodbridge, ON
- $16 to $25.8 CAD / hour
- Part-time
…presentation and operations of the store. S/he reports to the Store Manager in partnership with the Sales Manager. Bridal Stylists are brand ambassadors and demonstrate the values and…
Added 1 hour ago
RS
Development Manager, Brand Solutions & GTM
Rogers Sports & Media
Toronto, ON
- Full-time
Are you ready to take your career to new heights and be a part of a dynamic team at Rogers Sports & Media? We believe in creativity, innovation, and collaboration in everything we do, and…
Added 2 hours ago
HM
Family Practitioner/General Practitioner
Health Match BC
Nanaimo, BC
- Internship
Consider taking a shift at the Medical Arts Centre UPCC! Casual, full time or part time roles available.
Added 2 hours ago
WO
Modality Supervisor – X-Ray - Multiple sites
William Osler Health System
Brampton, ON
- Full-time
…delivering excellent patient care. The incumbent will support the manager in overseeing all aspects of modality operations including: quality management; staff productivity and human…
Added 2 hours ago
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Passenger Service Agent
Alliance Ground International
Richmond, BC · YVR Airport
- Part-time
…kept well-informed and are in the right place at the right time. Following safety, security, and airline-specific procedures, you’ll put our customers - and their customers’ needs at the…
Added 2 hours ago
LC
Strategic Analytic Coordinator
Langara College
Canada
- Full-time
Reporting to the Manager, Workday Sustainment and Support, this role supports on-time delivery of prioritized system related tasks and prepares in depth business and analytic reports for…
Added 3 hours ago
T
Seasonal Store Lead
Tilley
Vaughan, ON
- Part-time
We are currently seeking a Seasonal Part-Time Store Lead to join our Vaughan (ON) location. Our Store Leads bring fun, learning and confidence to parents & children by providing an…
Added 3 hours ago
SM
Manager, Finance, Performance & Analytics
Stevenson Memorial Hospital
Alliston, ON
- Full-time
Reporting to the Vice President, Corporate Services & Chief Financial Officer, the Manager, Finance, Performance and Analytics supports the hospital's strategic objectives, performance…
Added 3 hours ago
J
Case Manager – Drug Prior Authorization
Jobgether
Canada
- $43,875 to $73,125 CAD / year
- Full-time
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.
Added 3 hours ago
Retail Experience Lead
Fire & Flower Inc.
Beaumont, AB
Excellent organizational and time management skills.
Added 4 hours ago
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Animal Resources Division Manager – Montreal General Hospital Site
RI-MUHC | Research Institute of the MUHC | #rimuhc
Montreal, QC
- Full-time
…of the McGill University Health Centre (RI-MUHC), you can be part of an organization focused on scientific discovery and innovation in patient-centered medicine. Join us today and make a…

Jobgether

Case Manager – Drug Prior Authorization

Canada

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

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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.

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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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