Claims Examiner, Prior Authorization
Canada Life is a leading insurer serving the financial security needs of over 13 million people across Canada. The Prior Authorization Coordinator, Drug Services is responsible for assessing drug coverage requests and communicating decisions to plan members while ensuring compliance with group plan parameters.
Responsibilities
- Review medical information submitted by the patient’s physician to determine if all the necessary information has been received in order to complete the assessment. If not, must correspond with either the plan member or the physician to obtain any missing information
- Determine, based on the group plan parameters, if coverage is eligible under the group plan
- Review the medical information and determine if further investigation with the Medical Board is required or if the assessment can be made based on the information available to you
- Correspond both by phone and in writing with plan members to advise and support the decisions made
- Provide support to the Great-West Life Group Offices, Sales & Marketing Centers, Benefit Payment Offices, and Group Customer Contact Services regarding prior authorizations
Skills
- Ability to deliver high quality results with speed and accuracy in a fast paced challenging and ever-changing work environment
- Strong organizational, quality and time management skills
- Excellent analytical, investigative and problem-solving skills
- Strong customer service skills
- Excellent verbal and written communication skills
- Experience working in Excel, Word and Access
- Excellent keyboarding skills of 40wpm
- At ease navigating through multiple computer programs simultaneously
- Reliability Status security clearance - this is a personnel security status that is required before an employee can gain access to Protected B information, assets or work sites as outlined by the Government of Canada website
- Knowledge of the insurance industry and exposure to drug plans will be considered an asset
- Knowledge of BEN, TOCs, TSO and Cybrary will be considered an asset
- Bilingualism (English and French) is considered an asset
Company Overview