Senior Consultant – Prior-Authorization & Appeals Specialist

Role overview

Senior Consultant – Prior-Authorization & Appeals Specialist at CapeStart

We are seeking a Prior-Authorization & Appeals Specialist to build and operate an evidence-cited appeals capability that converts denied prior-authorizations and coverage decisions into recoverable revenue across both the medical and pharmacy benefit.

Required qualifications

• Minimum qualification: Degree in Life Sciences, Nursing, Pharmacy, Health Administration, or related field, with experience in payer operations, utilization management, or provider-side prior-authorization/appeals work.

Employment details

• Location: India

Additional role details

• This is a consulting/on-demand role supporting client engagements, with a strong emphasis on productizing the appeals process for repeatable use.
• The ideal candidate should be comfortable working directly from payer denial letters and patient records to build a defensible, tailored appeal.