Reimbursement Specialist Express Scripts Canada

Cigna Group; Mississauga; Hybrid; CAD 60,000 - 80,000; Full time

Job summary

A healthcare organization is seeking a Reimbursement Specialist in Mississauga to manage reimbursement processes for specialty medications. This role emphasizes patient advocacy and improving care outcomes by educating patients on their drug coverage and navigating reimbursement sources. The ideal candidate has a Bachelor's Degree and 3–5 years of experience in pharmacy benefit management or similar fields. Hybrid work model includes 2 days at the office per week.

Qualifications

• 3–5 years of experience in pharmacy benefit management, insurance, or pharmaceutical industries.
• Customer service and/or reimbursement background required.
• Demonstrated commitment to improving patient care.

Responsibilities

• Manage reimbursement processes for specialty medications.
• Educate patients on drug coverage and options.
• Drive process improvements for member experience.

Skills

Patient advocacy

Reimbursement management

Process improvement

Communication

Team collaboration

Education

Bachelor's Degree

Job description

Position Overview

The Reimbursement Specialist assumes responsibility for managing reimbursement related issues for patients requiring specialty medications. This role acts as a patient advocate and works closely with patients to navigate and secure potential sources of reimbursement, bringing more convenience, lower spend, and better health outcomes to patients.

Location & Work Environment

Mississauga Head Office – Hybrid 2 days per week.

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, and provide training to internal team members as required.
• Manage case‑by‑case reimbursement for patients requiring specialty medications; gather all pertinent information, coordinate patient cases, manage applications, and work directly with private, public, or manufacturer‑sponsored drug funding programs to optimize reimbursement.
• 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.
• Develop and maintain relationships with private/public payers, manufacturers, and plan sponsors; apply knowledge and insights to enhance specialty pharmacy service offerings.

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 background.
• Demonstrated commitment to improving patient care