Reimbursement Specialist

About the role

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions spanning the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris works on behalf of life sciences companies to improve patient experience, helping patients access and adhere to critical medications. The company supports more than 500 life sciences customers and has provided access and affordability support to millions of patients, with headquarters in Morrisville, North Carolina and Jeffersonville, Indiana. In this role you will provide in‑depth knowledge of client programs by working directly with patients, healthcare providers, and insurance companies to answer inquiries, process service requests, assess benefits coverage, and manage barriers to therapy in a compliant manner.

Responsibilities

• Perform patient‑level benefits verifications for major medical and pharmacy plans.
• Complete template forms that provide patient‑level benefits Coverage Determination Summaries.
• Coordinate prior authorizations based on payer guidelines and in compliance with law, regulation, or guidance.
• Review patient assistance enrollment forms and supporting documentation to assess eligibility per SOPs and program guidelines.
• Determine patient eligibility based on program criteria and communicate eligibility to patient, provider, and/or consignment pharmacy.
• Answer and assist inbound callers, resolving inquiries via FAQs or warm transfers to appropriate individuals.
• Actively listen to customers, assess needs, and respond with patience and courtesy.
• Review and identify missing or incorrect information in program service requests/applications.
• Report adverse events/product complaint inquiries according to SOP and good manufacturer practices.
• Provide timely feedback on service failures or customer concerns.
• Effectively use the internal technology platform (PharmaCord Lynk) to complete claims processing and keep workflows moving.
• Communicate with medical practice accounts and sales representatives regarding case status; provide consultative services to overcome obstacles and get patients on paid therapy.
• Perform additional tasks or projects as assigned.

Qualifications

• High school diploma or GED required; Bachelor's degree strongly preferred or equivalent experience.
• Minimum 6 months of customer service experience, payer benefits experience (reimbursement, prior authorization, etc.), healthcare industry experience, or healthcare‑related certification, license, or equivalent coursework strongly preferred.
• Bilingual ability is a plus.
• Ability to sit for extended periods; office‑based role with minimal travel as needed.

Skills

• Service‑minded with a focus on recognizing and meeting the needs of patients and care partners.
• Ability to handle personal health information with confidentiality.
• Commitment to honesty and integrity.
• Professionalism and proper business and customer‑service etiquette.