Reporting to the Clinical Services Manager, the Clinical Services Specialist is responsible for day-to-day operations supporting the Clinical Services team relating to Coverage Navigation Services and respond to client and member inquiries. 

Principal Responsibilities:                                                                                    

  • Receive, handle and evaluate coverage navigation applications
    • Manage all aspects required to obtain prescription drug coverage for patients
  • Maintain communication between internal and external stakeholders
    • Coordinate cases with public & private payers, physicians offices & pharmacies, and any relevant health care providers in order to maximize reimbursement options
    • Coordinate all documents and related paperwork to private & public payers
  • Liaise with internal stakeholders for report generation
  • Respond to client inquiries related to coverage navigation cases and provide status updates
  • Act as the primary resource of contact for members, internal partners and external clients
  • Maintain high standards of professional practice by adhering to the ethics of the profession and keeping abreast of the latest professional advances
  • Monitor Coverage navigation cases and ensure goals are met on daily, monthly and quarterly basis
  • Ensure continuity of care for cases is maintained and that any changes in application progress are clearly identified and transitioned accordingly
  • Provide written and verbal communication to members, clients, and internal partners
  • Identify process gaps, develop strategies to overcome operational challenges, and implement new processes as required
  • Assume responsibility for personal and professional development
    • Acquire and maintain extensive knowledge of private and provincial funding

   Knowledge, skills and experience: 

  • Post-secondary education is Mandatory;
  • Ability to organize, coordinate and prioritize own work;
  • Demonstrated strong ability to effectively communicate (verbal/written);
  • Previous experience working in Pharmacy setting is required (2-3 years);
  • Previous experience in pharmacy benefit management, insurance, and/or reimbursement is preferred
  • Knowledge and/or previous exposure to provincial and private drug plans, medication access and reimbursement programs;
  • Proven and demonstrated interpersonal and leadership skills;
  • Demonstrated capacity to liaise in a constructive and collaborative fashion with a variety of healthcare providers, clients and staff at various organizational levels;
  • Excellent analytical and problem solving skills;
  • Solid presentation skills;
  • Working knowledge of MS Office Applications is a MUST – Word, Excel, PowerPoint;
  • Demonstrated critical thinking, problem solving skills and attention to detail;
  • Demonstrated commitment to collaborative practice and lifelong learning;
  • Bilingualism (English/French) is an asset

Please send resume to Peter Doan at Peter.doan@claimsecure.com