Health Service Specialist

About the role

The Claims Processing and Refill Specialist plays a critical role in supporting patients' access to therapy by managing prescription refill requests, processing pharmacy claims, and coordinating resolution of reimbursement-related issues. This role serves as a liaison between patients, healthcare providers, pharmacies, payers, and internal teams to ensure timely medication access and continuity of care.

Responsibilities

• Serve as a primary point of contact for patients, caregivers, healthcare providers, and other stakeholders participating in patient support programs.
• Provide program education, guidance, and ongoing support to help patients navigate treatment-related processes and available resources.
• Cook up patient support services, ensuring timely completion of program activities and adherence to established guidelines.
• Facilitate communication between patients, providers, pharmacies, payers, and internal teams to help address barriers to care and therapy access.
• Support reimbursement and access-related activities, including benefit investigations, prior authorization coordination, patient assistance programs, and other program services.
• Conduct outbound and inbound calls to gather information, provide updates, and ensure patients receive the support needed throughout their treatment journey.
• Accurately document all interactions and case activities within web-based systems while maintaining compliance with company policies and regulatory requirements.
• Identify and escalate complex issues, patient concerns, or service-related challenges to the appropriate team members for resolution.
• Collaborate with cross-functional and multidisciplinary teams to improve patient experiences and program outcomes.
• Manage multiple cases and priorities while meeting quality, productivity, and service-level expectations.

Requirements

• Typically requires 3+ years of related experience.
• Excellent verbal and written communication skills with the ability to interact professionally with patients, providers, and healthcare stakeholders.
• Ability to build trust and maintain positive relationships with a diverse patient population.
• Strong problem-solving and critical-thinking abilities with the capacity to make sound decisions within established policies and procedures.
• Experience working with patient support programs, reimbursement services, healthcare access programs, specialty pharmacy, or related healthcare environments preferred.
• Proficiency with web-based systems, telephony platforms, and Microsoft Office applications.
• Exceptional organizational skills and attention to detail.
• Ability to manage a high-volume workload while maintaining accuracy and quality standards.
• Comfortable working independently with limited supervision and exercising judgment in routine and moderately complex situations.
• Knowledge of HIPAA, patient privacy regulations, and compliance requirements preferred.

Qualifications

• 3+ years of customer service, patient advocacy, or healthcare support experience.

Skills

• Strong problem-solving and critical-thinking abilities.
• Excellent verbal and written communication skills.
• Ability to build trust and maintain positive relationships with a diverse patient population.
• Proficiency with web-based systems, telephony platforms, and Microsoft Office applications.
• Exceptional organizational skills and attention to detail.
• Ability to manage a high-volume workload while maintaining accuracy and quality standards.
• Comfortable working independently with limited supervision and exercising judgment in routine and moderately complex situations.
• Knowledge of HIPAA, patient privacy regulations, and compliance requirements.

Benefits

We not only care about the wellbeing of our patients, customers and the communities we serve — we care about you. That’s why we provide our employees with a comprehensive support system for all aspects of Your Care: physical, emotional, financial and social.