Sr. Reimbursement Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Sr. Reimbursement Specialist based in United States.

This role supports patients, healthcare providers, payers, pharmacies, and other stakeholders throughout the reimbursement and therapy initiation process.
You’ll help patients access prescribed products by coordinating insurance verification, prior authorizations, orders, and coverage requirements.
The position combines specialized reimbursement knowledge with a strong focus on customer service and patient support.
You’ll manage detailed case information, monitor outstanding requirements, and help ensure files remain accurate and complete.
The role also involves coordinating with medical offices, sales representatives, pharmacies, homecare agencies, and internal teams.
Attention to detail, sound judgment, and the ability to manage multiple priorities are essential in this fast-paced environment.
This is a fixed-term opportunity running from October 12, 2026 through January 29, 2027, with a Monday–Friday, 8:00 AM–5:00 PM ET schedule.

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Accountabilities:

• Conduct benefit investigations and verify insurance coverage for patients and physicians’ offices.
• Submit prior authorization requests to payers and obtain required approvals.
• Manage recertification activities for cases requiring treatment or coverage beyond the original authorization period.
• Maintain accurate patient and case information in the designated client database and patient files.
• Monitor outstanding requirements and update case records so the team has clear visibility into current case status.
• Ensure patient files are complete, accurate, and maintained according to established processes and quality standards.
• Participate in conference calls with sales representatives, client management teams, and physicians’ offices regarding case status, drug orders, and alternative funding.
• Coordinate product orders, shipments, and therapy initiation with pharmacies and patients.
• Participate in call center activities and respond to inquiries from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies.
• Serve as a primary point of contact for an assigned group of prescribers when required.
• Educate patients, prescribers, and other stakeholders on applicable program requirements and processes.
• Facilitate appropriate referrals and coordinate follow-up activities throughout the patient support process.
• Identify and report events in accordance with applicable REMS requirements for specified medications.
• Recognize potential adverse events, product quality complaints, and other reportable risk events and route them to the appropriate team for manufacturer reporting.
• Maintain high standards of customer service and professional communication when interacting with patients, families, providers, and payer organizations.
• Maintain accurate documentation and follow established quality and production standards.
• Comply with applicable organizational, state, and federal safety and environmental policies and procedures.
• Balance multiple cases, priorities, and deadlines while maintaining accuracy and responsiveness.

Requirements:

• High School Diploma, GED, or equivalent professional experience.
• 4–6 years of experience in the insurance, biotechnology, pharmaceutical, customer service, or reimbursement fields.
• Experience with health insurance claims or patient accounting is a plus.
• Knowledge of reimbursement processes, third-party billing, and prior authorization procedures is preferred.
• Familiarity with medical terminology and healthcare-related processes is preferred.
• Knowledge of coding, appeals, and payer requirements is advantageous.
• Proficiency with Microsoft Office applications.
• Experience working with databases and case management systems is a plus.
• Strong written and verbal communication skills, with the ability to communicate effectively across different stakeholder groups.
• Ability to interact professionally with patients, families, healthcare providers, payers, pharmacies, and internal teams.
• Strong attention to detail and commitment to maintaining accurate case documentation.
• Good analytical and problem-solving skills.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Strong organizational and follow-through skills.
• Ability to understand and apply detailed program, payer, and reimbursement requirements.
• Ability to recognize and appropriately escalate adverse events, product quality complaints, and potential risk events.
• Commitment to quality, accountability, integrity, collaboration, and respectful interactions.
• Ability to work effectively in a remote environment while maintaining productivity and service standards.

Benefits:

• Remote work opportunities.
• Competitive salary.
• Opportunities for career growth and promotion.
• 401(k) with company match.
• Tuition reimbursement.
• Flexible work environment.
• Paid time off.
• Paid holidays.
• Employee assistance programs.
• Medical, dental, and vision coverage.
• HSA/FSA options.
• Telemedicine and virtual doctor appointments.
• Wellness program.
• Adoption assistance.
• Short-term disability coverage.
• Long-term disability coverage.
• Life insurance.
• Employee discount programs.

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How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

 Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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