Prior Authorization Representative

• Handle inbound and outbound injured workers provider adjuster pharmacy and internal/external stakeholder calls chats emails and interactive memos.
• Complete work within a proprietary system according to the assigned tasks.
• Execute tasks according to Standard Operating Procedures Client and Workers Compensation juris states regulatory requirements.
• Support pharmacies prescribers and internal/external stakeholders regarding inquiries and or issues related to Prior Authorization eligibility rejections and authorization management.
• Maintain productivity standards quality assurance performance guarantees and regulatory compliance.
• Work with internal/external stakeholders to research and resolve mail order specialty and retail pharmacy claims issues and respond within performance agreement guidelines and/or regulatory requirements.
• Maintain accurate complete and compliant documentation of all inquiries and resulting action.
• Identify and escalate concerns received from injured workers pharmacies or clients so that corrective action can be pursued in a timely manner.
• Responsible for good housekeeping techniques adhering to quality and production standards while complying with all applicable company state and federal safety requirements.
• Other duties as assigned

• Bachelors Degree Healthcare Allied courses preferred
• At least 1 year customer service experience
• Workers Compensation/US Healthcare Pharmacy Work Comp PBM or related experience are an advantage.
• General PC knowledge including Microsoft Office and Internet.
• Excellent verbal presentation and written communication skills.
• Ability to handle challenging interactions in a professional manner.
• Ability to adapt to a dynamic work environment.
• Ability to effectively multi-task within an omni-channel environment
• Ability to learn quickly solve problems and make decisions.
• Willingness to work on a flexible schedule for peak interaction and claims management times.
• Willing to work on site (Makati and/or Pasig City)
• Willing to work on shifting schedule (24/7 operation)

All qualified applicants will receive consideration for employment without regard to race color religion gender gender identity sexual orientation national origin ethnicity age disability marital status or any other characteristic protected by law.

Genfinity as an Equal Opportunity Employer believes in each persons potential and well help you achieve yours.

All information will be kept confidential according to EEO guidelines.

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