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25+ jobs

Added 11 mins ago
RE
AI Solutions Specialist - Co-op Student (Winter 2027)
Rodan Energy Solutions Inc.
Mississauga, ON
- Internship
…solutions that help clients reduce energy costs and GHG emissions, support electrification, and enhance grid efficiency. With over 20 years of expertise, we’re trusted by North America’s…
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Process Development Engineer
Active Dynamics
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- $62,000 to $72,000 CAD / year
- Full-time
…experienced Process Development Engineer (NPI & Production Support) to join our successful Toronto team! We are looking for a talent with solid professional skills in the manufacturing…
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Manufacturing Engineer
Active Dynamics
Toronto, ON
- $58,000 to $68,000 CAD / year
- Full-time
Active Dynamics is a progressive OEM supplier that designs, tests, and manufactures unique solutions for multiple systems and multiple industries. This full-service, end-to-end capabilities…
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HUMAN RESOURCES & PAYROLL COORDINATOR
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- Full-time
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Infection Control Practitioner
Ross Memorial Hospital
Kawartha Lakes, ON · Lindsay, ON
- Temporary
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Added 26 mins ago
RM
Infection Control Practitioner
Ross Memorial Hospital
Kawartha Lakes, ON · Lindsay, ON
- Full-time
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Added 26 mins ago
AC
Front Line Manager – Property Claims
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Municipal Support Officer - Regional Coverage
Integrated Municipal Support
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- Full-time
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Ongoing - Accounts Payable
RECRUITMENT PARTNERS INC.
Calgary, AB
- Contract
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Senior Accountant
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…financial results as reported through the cost and inventory systems by performing the following…
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Well-being: Access to our Employee Assistance Program (EAP), providing support for you and your family.
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Utility Operator, Permanent Full-Time
Lac La Biche County
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Manager, Income Property Accountant
MatchBox Consulting Group
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Inside Sales Coordinator
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Ottawa, ON · Greater Ottawa Metropolitan Area
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Field Placement Officer - Early Childhood Education - Appendix D/Temporary Assignment
Algonquin College of Applied Arts and Technology
Ottawa, ON
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Added 26 mins ago
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Administrative Assistant
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Added 26 mins ago
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Team Lead (Part time) - RW&CO Metrotown
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Senior Technology Architect
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Drug Prior Authorization Case Manager

Canada

Competitive salary range of $43,875–$73,125 CAD, depending on location, qualifications, experience, and other job-related factors. · Full-time

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Job details

Pay: Competitive salary range of $43,875–$73,125 CAD, depending on location, qualifications, experience, and other job-related factors.
Job type: Full-time
Experience: 2–3 years of experience in a customer-focused environment, case management, claims, or a related field.
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 Drug Prior Authorization Case Manager based in Canada.

This role is responsible for the end-to-end management of complex drug prior authorization and claims cases. You will independently assess requests against clinical guidelines, plan provisions, and approval criteria while ensuring accurate and timely decisions. The position involves direct communication with members, providers, pharmacies, and internal stakeholders. You will handle sensitive, escalated, high-value, and non-standard cases that require research, sound judgment, and detailed analysis. As a subject matter expert, you will also support internal teams, outsource partners, training, and knowledge-sharing initiatives. The role combines customer service, claims expertise, risk management, and continuous improvement within a collaborative and evolving environment.

\nAccountabilities:

Manage the intake, review, and adjudication of drug prior authorization requests, evaluating submissions against clinical guidelines, plan provisions, and established approval criteria.
Take full ownership of assigned cases from initial intake through resolution, prioritizing work according to urgency, complexity, customer impact, and service-level requirements.
Communicate authorization and claim outcomes clearly and professionally to members, healthcare providers, pharmacies, and internal stakeholders while maintaining expected turnaround times.
Investigate and resolve complex, escalated, sensitive, high-value, and non-standard claims or authorization scenarios through detailed research, analysis, and sound judgment.
Serve as a subject matter expert in prior authorization and claims adjudication, providing guidance to internal teams and external or outsourced partners.
Apply risk-management principles when assessing requests and contribute to effective resolution of escalated claims issues.
Participate in initiatives focused on operational efficiency, quality, customer experience, knowledge sharing, training, and continuous improvement.
Support broader organizational objectives related to financial efficiency, customer satisfaction, operational performance, and strategic priorities.

Requirements

Post-secondary education or an equivalent combination of education and relevant professional experience.
2–3 years of experience in a customer-focused environment, case management, claims, or a related field.
Previous experience in group benefits, claims management, disability management, insurance, or another regulated environment is required.
Proficiency with Microsoft Office 365 and confidence working with digital tools and systems in a professional environment.
Knowledge of benefits administration, medical and dental terminology, or claims-related practices is an asset.
Excellent written and verbal communication skills, with the ability to interact effectively with a diverse range of internal and external stakeholders.
Strong analytical, problem-solving, decision-making, and investigative skills, with the ability to assess risk and resolve challenging situations.
Strong attention to detail, sound judgment, confidentiality, and a customer-focused approach are essential.
Ability to manage multiple priorities in a fast-paced and changing environment while working independently and collaborating effectively with a team.
Strong influencing, negotiation, collaboration, and relationship-building skills, combined with adaptability and a willingness to embrace new technologies.
A continuous improvement mindset, solution-oriented approach, and experience acting as a subject matter expert, mentor, or informal leader are considered valuable.

Benefits

Competitive salary range of $43,875–$73,125 CAD, depending on location, qualifications, experience, and other job-related factors.
Opportunity to participate in incentive programs with compensation linked to individual and business performance.
Hybrid working arrangement with WorkSmart flexibility available.
Comprehensive health and dental coverage, including mental health and vision benefits.
Short- and long-term disability, life, and AD&D insurance coverage.
Adoption, surrogacy, wellness, and employee/family assistance benefits.
Retirement savings options, including pension and a global share ownership plan with employer matching contributions.
Access to financial education and counseling resources.
Generous paid time off, including holidays, vacation, personal and sick days, plus applicable statutory leaves.
Flexible and inclusive working environment focused on employee well-being, professional development, and career growth.
Opportunity to contribute to a global organization while developing expertise in complex claims and prior authorization management.

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.

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More about this job

Responsibilities

Manage the end-to-end adjudication of drug prior authorization requests by evaluating submissions against clinical guidelines and plan provisions. Investigate and resolve complex, escalated, or non-standard claims while serving as a subject matter expert for internal and external stakeholders.

Requirements

Requires post-secondary education and 2–3 years of experience in case management, claims, or group benefits. Candidates must possess strong analytical skills, proficiency with Microsoft Office 365, and the ability to work independently in a fast-paced environment.

Skills

Case management
Claims adjudication
Risk management
Clinical guidelines assessment
Medical terminology
Dental terminology
Analytical skills
Problem-solving
Decision-making
Communication
Negotiation
Relationship building
Microsoft Office 365
Benefits administration
Investigative skills
Customer service

Benefits

Health insurance
Dental coverage
Mental health benefits
Vision benefits
Short-term disability insurance
Long-term disability insurance
Life insurance
AD&D insurance
Adoption benefits
Surrogacy benefits
Wellness programs
Employee assistance program
Retirement savings plan
Pension plan
Share ownership plan
Paid time off

Visa sponsorship

Not detected in the job text

Keywords

Drug Prior Authorization
Case Management
Claims Adjudication
Group Benefits
Risk Management
Clinical Guidelines
Medical Terminology
Dental Terminology
Microsoft Office 365
Insurance
Disability Management
Customer Service
Analytical Skills
Problem-solving
Decision-making
Negotiation
Relationship Building
Operational Efficiency
Quality Assurance
Continuous Improvement
Subject Matter Expert
Hybrid Work
WorkSmart
Financial Efficiency
Stakeholder Management

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