Job Description

The Specialty Pharmacy Reimbursement Representative plays a crucial role in facilitating the financial and administrative processes associated with dispensing specialty medications. The primary responsibilities involve handling insurance claims, verifying benefits, and ensuring that payments are processed efficiently and accurately.Key Responsibilities:Verify patient insurance coverage for specialty medications and maintain prior authorization tracking.Ensure that all documentation required by insurance providers is complete and accurate.Prepare and submit receipts for specialty medications to Patient Support ProgramsTrack and monitor the status of submitted drug claims to all Insurance Providers and Patient support programs.Investigate and resolve claim denials or discrepancies, liaising with internal and external stakeholders as needed.Work closely with pharmacists, physicians, and other healthcare providers to ensure seamless renewal of prescriptionsFacilitate communication between providers and insurance companies to expedite the reimbursement process.Maintain accurate records of all insurance verifications, claims submissions, and communicationsPrepare reports on reimbursement activities and outcomes for management review.Assist in audits and compliance reviews related to reimbursement practices.Identify and resolve issues that may delay or prevent reimbursement.Collaborate with other team members to develop and implement solutions to complex reimbursement challenges and recommend process improvements to enhance efficiency and accuracy.Qualifications:1-2 years\xe2\x80\x99 experience as a pharmacy assistant preferred.Experience with Drug claim reconciliation an assetUnderstanding of private and provincial insurance reimbursement for specialty medications.Knowledge, Skills and Abilities required:Demonstrated attention to detail in handling complex financial transactions and maintaining accurate records.Ability to clearly and compassionately communicate with patients, healthcare providers, and insurance representatives.Capable of addressing and resolving issues related to insurance claims and payments efficiently.Internal application deadline: October 30, 2024Express Scripts Canada is a Cigna companyExpress 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 CanadaExpress 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\xe2\x84\xa2 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.It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.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.If you require accommodation in completing the online application process, please email: Do not email for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group