Special Authorization Facilitator
The Special Authorization Facilitator is responsible for frontline representation of ASEBP’s (and third party administrators) enhanced special authorization (ESA) program. The ESA program provides an additional review of certain medications in order to be eligible for benefit coverage.
The successful candidate will provide a high level of customer service to handle enhanced special authorization request in a timely, efficient manner ensuring established processes and procedures are followed. The role will also liaise with members, health care providers, third party adjudicators and internal staff to gather information needed for the program and communicate decisions that are made.
The successful candidate must be available to work four hours per day (20 hours per week), Monday to Friday between the hours of 8:00 a.m. and 5:00 p.m.
Your Key Responsibilities
- Assess completed new and renewal request forms for appropriateness, completeness, benefits eligibility, and coordination of benefits information.
- Create ESA cases within claims management system and transfer application information into case notes for adjudication.
- Facilitate the information exchange process within the claims management system between third party/internal adjudicator, the patient, the physician and/or other healthcare providers.
- Track progress of ESA cases to ensure the program is meeting the service agreement parameters.
- Triage renewal applications and direct to either third party or internal adjudication. Ensure the inclusion of claims history and that all relevant documents are accessible within the case.
- Provide guidance and assistance to covered members and their dependants with inquiries regarding the enhanced special authorization process and decisions.
- Identify members/dependants whose enhanced special authorization requests are due to expire within the next three months and notifies them in writing of the renewal process and their next steps.
- Assists the program manager, pharmacy services, pharmacist, and other specialty claims coordinator(s) with administrative tasks related to the enhanced special authorization process.
Your Education and Experience
- A minimum of three years of experience assisting customers in a benefits environment.
- Completion of a two-year technical or college certificate in group benefits, insurance and risk management, or pharmacy would be an asset.
- Proficient knowledge about group benefits and third party administration
- Excellent communication skills with an ability to communicate complex information.
- Ability to anticipate, identify and understand customer needs, and recognize when a referral to additional resources is necessary.
- Exceptional customer service focus which shows sensitivity, tact and professionalism.
- Ability to effectively and comfortably explore difficult and complex issues, and provide information, alternatives or suggestions.
- Intermediate skills in Microsoft Word and Excel. Experience with case management software is an asset.
- Good decision making and problem solving skills.
- Ability to work well in a multi-tasking environment.
About Alberta School Employee Benefit Plan
The Alberta School Employee Benefit Plan (ASEBP) is a health and welfare trust governed by ten Trustees, five of whom are appointed by the Alberta School Boards Association and five of whom are appointed by the Alberta Teachers' Association. ASEBP promotes programs that sustain healthy lifestyles and workplaces for over 56,000 covered members in almost 60 school jurisdictions across Alberta. These programs complement the comprehensive benefit coverage ASEBP offers to covered members.
Working for ASEBP is about more than supplying great health benefits. ASEBP offers:
- a team-focused culture that supports people and performance
- an exciting chance to make an impact in the lives of Alberta’s school employees
- a wide range of health and wellness initiatives that encompass emotional, physical and nutritional health
For more information about ASEBP, please visit the “About ASEBP” section of our website, asebp.ca.
How To Apply
If you have the required qualifications and would like to become a member of our team, please submit your resume quoting competition number #17-91 to:
Human Resource Services
No phone calls please. We thank all interested individuals, but only those candidates being considered for an interview will be contacted. ASEBP is an equal opportunity employer.