Appeals Technician (temp-to-hire)

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Capital Rx: A public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers.
• Judi Health™: Offering full-service health benefit management solutions to employers, TPAs, and health plans.
• Judi®: The industry’s leading proprietary Enterprise Health Platform (EHP), consolidating all claim administration-related workflows in one scalable, secure platform.

To learn more, visit www.judi.health.

Position Summary

Responsible for taking incoming requests for first, second level and external appeals while ensuring high level of customer service and maximizing productivity.

Position Responsibilities

• Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements.
• Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities.
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies.
• Review all cases received, to verify if case meets qualifications for appeal review.
• Performs triple check to ensure quality reviews and handling in accordance with policies and procedures.
• Updates case types, sends appeal acknowledgements, and submits case information to independent review organizations.
• Communicate effectively with appeal pharmacists regarding internal and external appeals.
• Make verbal outreach attempts to obtain necessary information for case review and record accurate information obtained on the call.
• Exhibit excellent phone and communication skills while providing complete and accurate information to members and providers.

Minimum Qualifications

• 1 + years’ experience working as a certified pharmacy technician in a managed care or PBM setting required.
• Active, unrestricted PTCB or NHA Certified Pharmacy Technician certification required.
• Excellent organization details and strong detail orientation.
• Strong oral and written communication skills.
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven environment with shifting priorities.
• Ability to work 12pm-9pm EST hours.

Preferred Qualifications

• Experience working with commercial and medicare appeals preferred.