Closed listing
Case Manager – Drug Prior Authorization
- Canada
$43,875 to $73,125 CAD / year · Full-time
This opening has closed.
The original listing is kept below for reference.
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
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Search current openingsOriginal job description
Archived listing. The details below describe a past opening.
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
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.
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.
- 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.
- 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.
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.
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
Categories
- Healthcare
- Customer Service & Support
- Administrative
- Management & Leadership
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