Sr. Reimbursement Specialist in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Sr. Reimbursement Specialist in the United States.

This role sits at the intersection of patient support, insurance coordination, and pharmaceutical access services, ensuring patients can successfully initiate and maintain access to prescribed therapies. You will serve as a key liaison between patients, healthcare providers, payers, pharmacies, and internal teams to navigate complex reimbursement pathways. The position requires strong attention to detail, deep understanding of insurance processes, and the ability to manage multiple cases simultaneously in a fast-paced, call center–style environment. You will conduct benefit investigations, support prior authorizations, and resolve coverage challenges to help minimize delays in treatment. With a strong focus on customer service and compliance, this role directly impacts patient outcomes and therapy access. It is ideal for a professional who thrives in problem-solving, coordination, and high-touch patient advocacy work within the healthcare ecosystem.

• Conduct insurance benefit investigations and verify coverage details for patients and healthcare providers.
• Initiate, track, and manage prior authorizations and recertifications to ensure continued therapy access.
• Maintain accurate and up-to-date patient and case data within internal systems and databases.
• Coordinate medication orders, product shipment, and therapy initiation with pharmacies and care teams.
• Serve as a communication hub between patients, physicians, insurers, home care providers, and internal stakeholders.
• Participate in call center operations, responding to inquiries and triaging incoming requests from multiple channels.
• Monitor case status, identify delays or issues, and proactively drive resolution through appropriate escalation paths.
• Support compliance by identifying and reporting adverse events, product quality issues, and risk-related events.
• Educate patients and providers on program requirements and reimbursement processes.
• Collaborate with internal teams and external partners through case updates, status calls, and coordination meetings.

• High school diploma or GED required; additional education in healthcare or related fields is a plus.
• 4–6 years of experience in insurance, biotechnology, pharmaceutical services, or healthcare reimbursement environments.
• Strong knowledge of third-party billing, medical terminology, coding, prior authorizations, and appeals processes (preferred).
• Experience with patient support programs, claims processing, or reimbursement operations is highly desirable.
• Proficiency in MS Office tools and experience working with databases or CRM/case management systems.
• Excellent verbal and written communication skills, with the ability to engage with patients and healthcare professionals at all levels.
• Strong organizational skills with the ability to manage multiple cases and competing priorities effectively.
• Detail-oriented mindset with strong analytical and problem-solving capabilities.
• Ability to work in a fast-paced, high-volume, customer-facing support environment.

• Remote work opportunities within the United States.
• Competitive salary and performance-based compensation structure.
• 401(k) retirement plan with company match.
• Comprehensive medical, dental, and vision insurance coverage.
• Flexible work environment with paid holidays and paid time off.
• Tuition reimbursement and ongoing professional development opportunities.
• Employee assistance programs and wellness resources.
• Health savings account (HSA) and flexible spending account (FSA) options.
• Life insurance and short- and long-term disability coverage.
• Telemedicine access and virtual healthcare services.
• Adoption assistance and employee discount programs.
• Career growth opportunities within a supportive, mission-driven environment.