Pharmacy Prior Authorization Senior Representative - Freedom Fertility - Remote AZ or IL or MA

Cigna Group • Tempe, AZ

4d • Remote

About The Position

The Pharmacy Prior Authorization Senior Representative works on a specialized, high-touch team supporting patients associated with a specific group of clinics. The role focuses on researching pharmacy benefits, obtaining prior authorizations, processing prescription orders and claims, and communicating with internal sales teams, patients, and providers. Representatives use internal and external pharmacy and clinic systems, including clinic-specific EMRs, to complete the prior authorization process and help ensure prescriptions are processed and dispensed accurately. The position requires careful attention to detail, strong customer service, and the ability to manage multiple tasks. The role is remote for candidates in Arizona, Illinois, or Massachusetts, subject to the stated home internet requirements.

Requirements

• High school diploma or GED.
• At least 2 years of Pharmacy Technician experience.
• Valid National Pharmacy Technician certification.
• Valid Arizona, Massachusetts, or Illinois state pharmacy technician license.
• Proficiency with Microsoft Office and data entry.
• Strong math skills related to prescription calculations.
• Exceptional attention to detail, accuracy, and quality.
• Excellent verbal and written communication skills.
• Ability to multitask across computer and phone tasks.
• At least 1 year of relevant experience submitting prior authorizations using CoverMyMeds or similar electronic prior authorization tools.
• Ability to work the schedule determined by location and business need, including a Monday–Friday training shift of 8:30 AM–5:00 PM EST, a Monday–Friday scheduled 8-hour shift of 12:30 PM–9:00 PM EST, and weekends as needed.
• For home work, internet service must be through a cable broadband or fiber optic provider with speeds of at least 10 Mbps download and 5 Mbps upload.
• Effectively foster teamwork and take ownership of projects.
• Build strong working relationships with colleagues and customers.
• Prioritize and manage workload, meet deadlines, and deliver results.

Nice To Haves

• Experience with prior authorization appeals and denials.
• Experience working with clinical EMR systems.
• Experience in infertility.

Responsibilities

• Enter prescriptions accurately, adjudicate claims, and resolve claim rejections.
• Use clinic-specific EMR systems to obtain information needed to submit prior authorizations.
• Follow program-specific contractual agreements and company practices.
• Investigate processing and benefit inquiries from the Fertility Inside Sales team, including insurance inquiries and benefit checks.
• Submit prior authorizations, follow up on submissions, and handle appeals as needed.
• Manage multiple tasks while maintaining attention to detail and accuracy.
• Help patients and providers understand pharmacy benefits and answer their questions.
• Respond to internal and external inquiries regarding prior authorizations.
• Participate in program-specific customer meetings and training sessions.
• Participate in special projects and perform other duties related to specific contract performance.

Benefits

• Eligibility to participate in an annual bonus plan.
• Medical benefits.
• Vision insurance.
• Dental insurance.
• Well-being and behavioral health programs.
• 401(k).
• Company-paid life insurance.
• Tuition reimbursement.
• At least 18 days of paid time off per year.
• Paid holidays.
• Leaves of absence.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED