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Reimbursement Specialist

4 months ago

Mississauga, Ontario, Canada The Cigna Group Full time
The Reimbursement Specialist assumes responsibility for managing reimbursement related issues for patients requiring specialty medications.

This role will act as the patient advocate and work closely with patients to navigate and secure potential sources of reimbursement.

Together with the pharmacy services, this role will bring more convenience, lower spend, and better health outcomes to patients.

ESSENTIAL FUNCTIONS:


Determine operational processes, and lead internal and external teams in implementation of program launch and ongoing utilization through assigned and self-initiated "pull through" efforts.

Drive continual process improvements to enhance work efficiencies and optimize member experience. Provide training to internal team members as required.

Communicate and educate patients regarding their private drug coverage and options, including status of Prior Authorization requests.

Identify and resolve reimbursement issues to facilitate pharmacy processes including prescription processing and invoicing.


Identify gaps and opportunities for clinical education and healthcare support, and liaise with the appropriate internal teams or external organizations to provide and enhance patient care.

Maintain and manage standard operating procedures and specialty medication funding program database.

QUALIFICATIONS:

Bachelor's Degree preferred

3-5 years of experience in the pharmacy benefit management, insurance, pharmacy, biotechnology, or pharmaceutical industries; customer service and/or reimbursement.

Demonstrated commitment to improve patient care

Able to work independently and within a team

Excellent written/verbal communication to include providing clear instructions

Ability to multitask

Strong problem-solving skills with the ability to resolve issues effectively and efficiently

Knowledge of the private or public drug reimbursement would be an asset

Knowledge of pharmacy dispensing software is preferred

NOTE:
Internal posting will be closed on July 27, 2023.

Express Scripts Canada is a Cigna company
Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company

Cigna Corporation (NYSE:
CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve.

Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

About Express Scripts Canada
Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada's leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment.

We provide Active Pharmacy services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually.

Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.


We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.

We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace.

By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.


We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.