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Director Insurance Prior Authorization Jobs in Decatur, GA

Walgreens

Specialty Billing Technician

Atlanta, GA · On-site

$20.25 - $26/hr

Process and file all SDL (submit direct link) claims in accordance with company policy. * Processing of prescription exceptions including prior authorizations, triaging of referrals to other ...

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Director Insurance Prior Authorization information

What does a Director of Insurance Prior Authorization do?

A Director of Insurance Prior Authorization oversees the processes required to obtain insurance approvals for medical procedures, prescriptions, or treatments. They manage teams responsible for submitting prior authorization requests and ensure compliance with insurance guidelines and regulations. Their role includes improving workflow efficiency, reducing denials, and collaborating with healthcare providers and insurance companies. Additionally, they analyze trends to optimize the authorization process and provide training to staff on policy changes.

What is the difference between Director Insurance Prior Authorization vs Insurance Authorization Specialist?

AspectDirector Insurance Prior AuthorizationInsurance Authorization Specialist
CredentialsBachelor's degree, industry certifications often preferredHigh school diploma or equivalent, relevant certifications beneficial
Work EnvironmentManagement level, overseeing teams and processesOperational role, performing authorization tasks
Employer & Industry UsageHospitals, insurance companies, healthcare organizationsMedical offices, insurance companies, healthcare providers
Primary ResponsibilitiesOverseeing authorization processes, policy compliance, team managementProcessing authorization requests, verifying coverage, documentation

The main difference is that the Director Insurance Prior Authorization manages teams and oversees authorization policies, while the Insurance Authorization Specialist handles the day-to-day processing of authorization requests. Both roles require knowledge of insurance policies, but the director position involves leadership and strategic oversight.

What are the key skills and qualifications needed to thrive as a Director of Insurance Prior Authorization, and why are they important?

To thrive as a Director of Insurance Prior Authorization, you need expertise in healthcare administration, insurance processes, and regulatory compliance, typically supported by a bachelor's or master's degree in healthcare or business administration. Familiarity with prior authorization software, electronic health records (EHRs), and payer systems is crucial for overseeing efficient authorization workflows. Strong leadership, problem-solving, and communication skills help drive team performance and manage complex stakeholder relationships. These skills ensure timely approvals, reduce claim denials, and maintain regulatory compliance, which directly impact patient access and organizational revenue.

What are some common challenges faced by a Director of Insurance Prior Authorization, and how can they be effectively managed?

A Director of Insurance Prior Authorization often encounters challenges such as navigating constantly changing insurance requirements, ensuring timely approvals for patient care, and managing high volumes of authorization requests. Effective management involves staying updated on payer policies, implementing robust tracking systems, and fostering strong communication between clinical, administrative, and payer teams. Building a knowledgeable team and utilizing technology to streamline workflows can also help reduce denials and improve turnaround times.
What job categories do people searching Director Insurance Prior Authorization jobs in Decatur, GA look for? The top searched job categories for Director Insurance Prior Authorization jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Director Insurance Prior Authorization jobs? Cities near Decatur, GA with the most Director Insurance Prior Authorization job openings:
Director Insurance Prior Authorization jobs near you
Manager, Insurance Regulatory Compliance

Manager, Insurance Regulatory Compliance

INHABIT IQ

Alpharetta, GA • On-site, Remote

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 25 days ago

Job description

About Inhabit

Inhabit is a global PropTech software company serving over 5 million units in the residential and short-term rental property management industries. Our 1,500+ team members drive strategic partnerships, deliver best-in-class software solutions and services, and foster innovation and collaboration across software, payments, and insurance. Learn more at, visit inhabit.com.

Job Description Summary

The Manager, Insurance Regulatory Compliance plays a critical role in supporting a multi-state MGA operating model, ensuring compliance with state insurance regulatory requirements across delegated authority programs, partner relationships, and product offerings.
This role is responsible for supporting the Director, Insurance Regulatory Compliance with regulatory operations that commonly sit within an MGA environment, including regulatory inquiries and examinations, consumer complaints, partner compliance oversight, and coordination with carrier partners on filings and regulatory obligations. The Manager acts as a key compliance advisor to internal business teams and external partners, translating regulatory requirements into practical, scalable guidance.
As a people manager, this role owns key compliance programs (e.g., complaints management, compliance testing and monitoring), educates business partners on regulatory risk, and coaches and mentors junior-level compliance team members.

What You’ll Do (Functions & Responsibilities)

MGA Regulatory Compliance & Oversight

  • Serve as a point of contact for regulatory inquiries, data calls, examinations, and audits affecting MGA operations and delegated authority programs.
  • Coordinate responses to DOI requests in collaboration with internal teams, carrier partners, and external advisors.
  • Monitor state regulatory, legislative, and bureau changes relevant to MGA operations and support implementation efforts.
  • Conduct compliance reviews of partner programs, delegated authority arrangements, and third-party vendors.

Program Ownership & Compliance Operations

  • Own and manage core MGA compliance programs, including regulatory complaint management, compliance monitoring, and testing activities.
  • Oversee intake, investigation, documentation, and resolution of regulatory and consumer complaints.
  • Support risk-based reviews of underwriting, policy administration, disclosures, and producer-related activities.
  • Contribute to internal audits, compliance reporting, remediation tracking, and governance activities.

Carrier & Partner Collaboration

  • Partner with carrier compliance teams on regulatory interpretations, filing responsibilities, audits, and examinations.
  • Support oversight of delegated authority relationships and adherence to carrier agreements.
  • Serve as a liaison between carrier requirements and MGA business teams.

Business Advisory & Education

  • Act as a trusted advisor to Product, Operations, Technology, and Partner teams.
  • Educate business partners on regulatory obligations and emerging risks.
  • Support compliant process design for new products, states, and partner programs.

People Leadership & Development

  • Lead, coach, and mentor junior compliance team members.
  • Set performance expectations and support professional development.
  • Assist with workload planning and prioritization.

What We’re Looking For (Minimum qualifications)

  • 7–10+ years of insurance regulatory compliance experience.
  • Working knowledge of multi-state DOI regulations, examinations, complaints, and filings.
  • Experience partnering with carrier compliance teams.
  • Demonstrated compliance program ownership.
  • Strong analytical and communication skills.
  • Experience in an MGA, InsurTech, or carrier supporting MGA programs.
  • Familiarity with personal and/or surplus lines insurance.
  • Prior people-management experience.
  • Compliance or insurance certifications a plus.
  • Strong ownership mindset with practical compliance approach.
  • Effective cross-functional collaborator.
  • Clear communicator and educator.
  • Comfortable in fast-paced, regulated environments.

Education

  • Bachelor’s degree in business administration, supply chain management, or a related field.

Type

  • Full-Time, Salaried Exempt 

Location

  • We have an in-office work style, with most team members working in the office from Monday to Thursday and remotely on Friday.

Benefits Include

  • Competitive Pay
  • Health Insurance: Medical, Dental, Vision and Prescription Plans
  • Health Savings Accounts
  • Flexible Spending Account
  • Dependent Flexible Spending Account
  • Critical Illness
  • Accident
  • 401k Plan with discretionary company match
  • Short- and Long-Term Disability
  • Company Paid $25,000.00 life insurance
  • Supplemental Life and AD&D Insurance
  • Employee Assistance Program
  • Paid Holidays
  • Paid Vacation
  • Paid Volunteer Time
  • Inhabit Employee Discount Programs

Our Company is an Equal Opportunity Employer and complies with all federal, state, and local laws, including providing reasonable accommodations to applicants.

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