Job Description
Join our team as a Pharmacy Technician in the Appeals department, where you will handle Prior Authorizations (PAs) going through the appeals process following a denial. You will work on Medicare and Medicaid appeal requests, including direct member reimbursements, process claims, review clinical criteria, and handle authorizations.
ResponsibilitiesProcess appeal requests related to Medicare and Medicaid, including direct member reimbursements.Handle claims processing and review clinical criteria for authorizations.Maintain a performance rate of 90% or better, handling an average of 28 cases per day with a 95% or better quality score.Essential SkillsPharmacy Technician License.Strong customer service skills.Experience with prior authorization and insurance processes.Proficiency in data entry and computer skills, including Microsoft Office and Outlook.Attention to detail and ability to meet tight turnaround times.Minimum of 2 years of experience in retail, payor, or hospital pharmacy settings.Additional Skills & QualificationsCertification as a Pharmacy Technician is preferred.Experience in managed care is a plus.Ability to work independently and adapt to change.Work Environment
This is a 100% remote position requiring a quiet and closed-door setting with strong WiFi. Work hours are Monday to Friday, 8am-8pm in your time zone, with rotating weekends every 4-6 weeks and potential holiday work. Training lasts two weeks, Monday to Friday, from 10am to 6:30pm, followed by regular working hours in your timezone. Enjoy a supportive work culture with continuous training, career advancement opportunities, and benefits including PTO and holiday pay.
Contact number- 904 530 5416
Pay and BenefitsThe pay range for this position is $18.00 - $22.00/hr.
Eligibility requirements apply to some benefits and may depend on your job
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Aug 7, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.