Senior Consultant Prior Authorization & Appeals Specialist Bengaluru

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 perk. This is a consulting/on-demand role supporting client engagements, with a robust 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. Review denied prior-authorization and coverage decisions against payer/plan coverage and formulary criteria Extract and match supporting clinical facts from the patient record (EHR-driven) to plan criteria and published literature/compendia Draft tailored medical-necessity and exception letters formulary, step-therapy, and tiering exceptions for drugs; procedure and claim-denial appeals for devices Route appeals through the appropriate payer appeal levels and track outcomes Build and maintain template and coverage-criteria libraries to productize the appeals workflow Ensure all appeals work stays within compliance guardrails (HIPAA and payer-specific rules) Collaborate with clinical, regulatory, and coding colleagues to strengthen appeal arguments Train internal team members on appeals methodology and payer-criteria interpretation .