Specialty Medication Adjudicator

7 days ago

Hamilton, Canada Charlton Health Group Full time

**Job Summary**

**Responsibilities**
- Review and process specialty medication claims in accordance with established policies and procedures.
- Verify patient eligibility and benefits for specialty medications, ensuring compliance with insurance requirements.
- Collaborate with healthcare providers to obtain necessary documentation for claim approval.
- Resolve discrepancies or issues related to claims, including appeals for denied claims.
- Maintain accurate records of adjudicated claims and communicate effectively with all stakeholders involved.
- Stay updated on changes in medication guidelines, insurance policies, and industry regulations impacting specialty medications.
- Provide exceptional customer service to patients, healthcare providers, and pharmacy staff throughout the adjudication process.

**Skills**
- Strong analytical skills with attention to detail for accurate claim processing.
- Excellent communication skills, both verbal and written, to effectively interact with various stakeholders.
- Proficiency in navigating electronic health records (EHR), we use **Accuro**, and pharmacy management systems - **KROLL**:

- Knowledge of pharmacy benefits management (PBM) processes and specialty medications is preferred.
- Ability to work independently as well as part of a team in a fast-paced environment.
- Problem-solving skills to address complex issues related to medication coverage and reimbursement effectively.
- Familiarity with medical terminology and pharmaceutical concepts is advantageous.

This position is essential in ensuring that patients receive the medications they need without unnecessary delays or complications, making it a rewarding opportunity for individuals passionate about improving healthcare outcomes.

**Benefits**:

- On-site parking
- Paid time off

Flexible language requirement:

- French not required

Schedule:

- Monday to Friday

Ability to commute/relocate:

- Hamilton, ON: reliably commute or plan to relocate before starting work (required)

**Location**:

- Hamilton, ON (required)

Work Location: In person

Application deadline: 2025-04-25
Expected start date: 2025-04-28

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