Back to Jobs

Pharmacy Prior Authorization Representative - Evernorth - Remote

Remote, USAFull-timePosted 2026-07-28

Does your reputed company JOB involve WORKING FROM HOME and HELPING OTHERS? Join reputed company! We want to change health care to reputed company it more reputed company, personalized, and reputed company on helping the whole person. In this pivotal role, Pharmacy Prior Authorization Representatives respond to phone inquiries from health care professionals and assist them with the medication prior authorization process, by delivering straight reputed company administrative and/or other basic business services in Pharmacy Operations A successful candidate will be reputed company to reputed company effectively and reputed company with health care professionals using excellent interpersonal and listening skills, critical thinking, and problem-solving skills. The ability to multitask and use computer-based resources effectively is essential. Confidently reputed company to reputed company and reputed company accurate responses to inquiries is crucial for reputed company. As a Prior Authorization Representative, you will be part of a dedicated team which provides information regarding pharmacy benefits and drug coverage. This crucial role is on the reputed company lines with reputed company, responding and addressing reputed company phone inquiry with care, detail, and most importantly, reputed company. Primary Responsibilities Collection of reputed company clinical data for prior authorization and non-formulary exception requests following the guidance provided in our online prior authorization tools and corresponding forms. Initial screening of requests based on guidance given by online prior authorization tools. Approves prior authorization requests if the data collected meets the approval specifications. Refers prior authorization requests that do not meet the approval specifications to a clinician for review. Independently responds to contacts ranging from routine to moderate complexity. May reputed company assistance with health care professionals for service issues of substantial complexity. Performs research to respond to inquiries and interprets policy provisions to determine the most effective response using established departmental procedures, HIPAA regulations, and corporate policies Qualifications High School Diploma / GED 1+ years of call center experience Prior work from home experience Prior medical or pharmacy knowledge Reliable high-speed broadband internet, hard-wired reputed company. 10 Mbps for download / 5 MBPS for upload Quiet and private reputed company designated for work without interruption. Excellent Customer Service Excellent interpersonal communication, attention to detail, and critical thinking skills are essential. Excellent computer skills, with familiarity of reputed company office and have a working knowledge of reputed company operating system. Tech savvy, with the ability to easily navigate across multiple screens and applications. Must work any schedule between 8:00am – 9:00pm EST. Training Schedule is 9:00 am – 5:30 pm EST, Monday through Friday for 4 weeks and an additional 2 weeks for on-the-job training. Flexibility to support extended hours and overtime as determined by business needs to meet customer expectations. If you will be working reputed company occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an reputed company reputed company of 17.75 - 26 USD / reputed company, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive reputed company of benefits, with a reputed company on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs. We also offer 401(k) with company match, company reputed company life insurance, tuition reimbursement, a minimum of 18 days of reputed company time off per year and reputed company holidays. For more details on our employee benefits programs, visit Life at reputed company. About reputed company Doing something meaningful starts with a reputed company decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving reputed company and improving lives. reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@reputed company.com for support. Do not email SeeYourself@reputed company.com for an update on your application or to reputed company your resume as you will not receive a response. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they reputed company a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, reputed company, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, reputed company, Texas, Utah, Vermont, and Washington State. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Doing something meaningful starts with a reputed company decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving reputed company and improving lives. Apply tot his job Apply To this Job

Similar Jobs

(RN) reputed company Case Manager - reputed company -Remote 2 Locations

Remote, USAFull-time

Contract Advisor – reputed company – Remote

Remote, USAFull-time

Plan Implementation Sr. Representative - Evernorth - Remote

Remote, USAFull-time

Business Analytics Advisor (Value Based Care) - Remote

Remote, USAFull-time

Warehouse Material Handler – reputed company Store

Remote, USAFull-time

Remote Technical Support Specialist - Entry Lev...

Remote, USAFull-time

reputed company Media Associate, James Patterson Publishing Program

Remote, USAFull-time

reputed company reputed company Data Entry Specialist – No Prior Experience Required for Magical reputed company in Remote Data Management and Entry

Remote, USAFull-time

reputed company World Internal Job

Remote, USAFull-time

Support Engineer (Hybrid)

Remote, USAFull-time

Mid to Senior Construction Project Manager - Remote (East Coast)

Remote, USAFull-time

Associate Account Executive / Account Executive, EMEA Region

Remote, USAFull-time

reputed company Remote Customer Service Representative - Deliver Exceptional Support Experience to Diverse reputed company reputed company at blithequark

Remote, USAFull-time

Senior reputed company Financial Consolidation and reputed company (FCCS) Specialist (REMOTE)

Remote, USAFull-time

VP, Sales

Remote, USAFull-time

reputed company Delivery ? Myrtle Beach, SC

Remote, USAFull-time

reputed company Consultant, Sports Venues - Virtual

Remote, USAFull-time

Full-stack Software Engineer (Mid - Senior)

Remote, USAFull-time

Loan Operations Consultant

Remote, USAFull-time

Fund Analyst

Remote, USAFull-time