Remote Optum Prior Authorization Jobs in Wheaton, IL

Job Title: Prior Authorization Representative – Complex Authorizations

Industry: Specialty Pharmacy / Healthcare

Location (city, state): Elk Grove Village, IL or Columbus, OH – Local Remote

Assignment Type: Contract-to-Hire

Pay: $23.00 / hour

Work Schedule: Monday–Friday, 8-hour day shift. Regular hours are approximately 8:00 AM–4:30 PM CT. Training hours are approximately 8:30 AM–5:00 PM CT.

Benefits: This position is eligible for medical, dental, vision, and 401(k).

About The Company:

A growing specialty pharmacy organization is expanding its Complex Authorizations team to support increased demand for specialized and rare medications. This team works closely with patients, insurance carriers, and healthcare partners to navigate complex medication approval processes.

Job Description:

The Prior Authorization Representative will manage authorization requests for specialty medications and help ensure cases move efficiently through the insurance approval process. The ideal candidate will have experience with prior authorizations, pharmacy, healthcare insurance, or medical benefits and be comfortable working with detailed documentation and payer requirements.

Key Responsibilities:

• Submit and manage prior authorization requests for specialty and complex medications.
• Navigate insurance and payer portals to research benefits and complete authorization requirements.
• Review medical and insurance documentation for accuracy and completeness.
• Assist with medication conversion processes and perform basic multiplication and division calculations.
• Work with cases involving medical benefits and home infusion services.
• Track authorization cases and follow up on outstanding insurance requirements.
• Maintain accurate case documentation and records.
• Participate in daily team meetings and communicate case updates.
• Meet established productivity and quality expectations.
• Work independently while remaining receptive to coaching and feedback.

Qualifications:

• Prior authorization experience strongly preferred, particularly pharmacy benefit authorizations.
• Experience using insurance portals or payer websites.
• Understanding of medical insurance benefits and healthcare terminology.
• Pharmacy, specialty pharmacy, healthcare insurance, or medical office experience.
• Retail pharmacy experience with employers such as CVS or Walgreens is a plus.
• Pharmacy Technician experience is preferred but not required.
• PCP/medical office experience involving insurance processes may be considered.
• Comfortable performing basic math calculations, including multiplication and division.
• Strong attention to detail and documentation skills.
• Self-motivated, dependable, and able to work independently.
• Coachable with a willingness to learn new processes.

Additional Details:

• 1 position available.
• Target start date: September 21, 2026.
• Initial training is expected to be onsite for approximately two weeks and may be extended based on training needs.
• After successfully completing training, employees may transition to remote work.
• Candidates must live within approximately 50–60 miles of Elk Grove Village, IL or Columbus, OH.
• This is a local remote position, and employees must be able to report onsite if business needs require it.
• Candidates should be comfortable working in an environment with productivity tracking and leadership visibility.

Perks:

• Contract-to-hire opportunity with long-term potential.
• Remote work opportunity following training.
• Specialized training and onboarding.
• Supportive leadership and coaching.
• Exposure to complex specialty pharmacy and rare-drug workflows.
• Opportunity for professional growth and future advancement.
• Join a growing team with potential for additional opportunities as the organization expands.

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.

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