Authorizations Specialist, US Healthcare

iSTA Solutions

. Manage insurance authorization requests from submission through approval, denial, or reauthorization .

Posted 9/22/2026full-timeRemote • South AfricaMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing insurance authorizations, including prior authorizations and payer requirements, while ensuring compliance and accuracy in patient information management. Proficient in coordinating workflows and collaborating with healthcare providers and internal teams to enhance operational efficiency.

Highest-signal resume keywords

Healthcare Insurance AuthorizationsPayer Requirements ManagementSalesforce ExperienceMedical BillingStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior AuthorizationsBenefits VerificationClaims ProcessingUtilization ManagementPatient Information ManagementPharmacy Prior AuthorizationsEvaluation DocumentationWorkflow DevelopmentCompliance ProgramsSingle Case Agreements

Soft Skills

Organizational SkillsTime-Management SkillsProblem-Solving SkillsAttention to DetailProactive Attitude

Tools & Technologies

Payer PortalsOnline Healthcare Enrollment SystemsSalesforceBilling SystemsCommunication Platforms

Industry Keywords

U.S. HealthcareInsurance ProvidersMedical AidsPatient CareConfidentiality

About the role

Key responsibilities & impact

Manage insurance authorization requests from submission through approval, denial, or reauthorization
Review patient information and clinical documentation to ensure payer and authorization requirements are met
Monitor authorization statuses, expiration dates, and upcoming appointments to identify gaps or delays
Coordinate Single Case Agreements (SCAs) and provide status updates to relevant teams
Complete online enrolments relating to compliance programs, patient benefits, and payer or treatment requirements
Manage payer-specific requirements, including TRICARE referrals and authorizations
Process and monitor pharmacy prior authorizations and medication-related approvals
Maintain accurate authorization, payer, enrolment, and patient information in Salesforce and other relevant systems
Prepare and manage evaluation and billing-related documentation
Communicate with insurance carriers, billing partners, healthcare providers, pharmacy partners, and internal teams
Follow up on outstanding requests, missing documentation, denials, enrolments, and other treatment barriers
Complete required reports and assist with monitoring authorization and patient scheduling activity
Assist with developing and documenting authorization, enrolment, and payer-specific workflows
Support system and workflow improvement initiatives to increase efficiency and reduce delays in patient care

Requirements

What you’ll need

Previous experience in healthcare insurance authorizations, medical aid authorizations, benefits verification, medical billing, claims, utilization management, or related healthcare administration is preferred
Experience working with medical aids, insurance providers, payer portals, or online healthcare enrollment systems is advantageous
Good understanding of insurance benefits, prior authorizations, referrals, claims, and payer requirements is preferred
Strong organisational and time-management skills, with excellent attention to detail and accuracy
Strong written and verbal communication skills
Ability to manage multiple cases, priorities, deadlines, and follow-ups simultaneously
Strong problem-solving and critical-thinking skills
Proactive and self-motivated, with the ability to independently follow up on outstanding tasks and see them through to completion
Comfortable working with technology and learning new systems; Salesforce experience is a plus
Ability to work collaboratively with clinical, administrative, billing, pharmacy, and other internal teams
Ability to maintain confidentiality and appropriately handle sensitive patient information
Adaptable and comfortable working in an environment where processes and workflows may continue to develop and improve
Previous experience supporting a U.S. healthcare client or working with U.S. insurance/payer requirements is advantageous
Monday–Friday availability for 09:00–18:00 EST / 15:00–00:00 South African time, subject to daylight savings
Ability to work on South African and U.S. public holidays
Fixed fibre line with minimum 25 Mbps upload and download speeds and wired Ethernet capability
Reliable power backup for load shedding or outages

Benefits

Comp & perks

Compensation for South African public holidays in accordance with the BCEA
Fully remote work arrangement