Job Description
📍 Cebu, Philippines (Onsite) | 🕘 Monday–Friday | 💼 Full-Time
About the Role
We are seeking a Prior Authorization Specialist to join our team in Cebu. In this role, you will be responsible for reviewing, evaluating, and processing prior authorization requests to ensure compliance with clinical guidelines, client requirements, and pharmacy benefit policies.
You will perform detailed reviews of medication requests, validate supporting clinical documentation, apply established authorization criteria, and make accurate determinations within defined turnaround times. You will also collaborate with internal clinical, operational, and account teams to resolve authorization-related issues, support the implementation of new or updated guidelines, and maintain the integrity of authorization processes.
Key Responsibilities
- Review prior authorization submissions and research app...