Utilization Management Appeals Technician (Temp to Hire)

About Judi Health Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers. Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans. Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit Position Summary Responsible for taking incoming requests for first, second level and external appeals while ensuring a high level of customer service and maximizing productivity. Work with the appeals team for multiple lines of business such as Commercial, Exchange, and Medicare, ensuring the proper submission of appeals for review by pharmacist and medical directors. 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 them to daily responsibilities. Follow all internal standard operating procedures and adhere to HIPAA guidelines and policies. Review all cases received to verify if a case meets qualifications for appeal review. Perform triple checks to ensure quality reviews and handling in accordance with policies and procedures. Update case types, send appeal acknowledgements, and submit 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. Perform all other related duties as assigned. Minimum Qualifications 1+ years’ experience working as a certified pharmacy technician in a managed care or PBM setting. Active, unrestricted certified pharmacist technician license. Excellent organizational detail 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 12 pm‑9 pm EST hours. Preferred Qualifications Experience working with commercial and Medicare appeals. Salary ranges: Remote, US: $60,000—$65,000 USD New York, NY: $78,800—$98,500 USD Denver, CO: $72,000—$90,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non‑compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health’s privacy practices can be found at #J-18808-Ljbffr Capital Rx