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2 active postings matched department "Claims Advocacy". Showing the first 2 jobs.
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| Title | Company | Location | Role group | ATS | Work | Salary | Dates |
|---|---|---|---|---|---|---|---|
| Case Manager | Bayshore Bs Ex En | Mississauga, ON, Canada | !*!%3Cp%3E%3Cmeta content=%22text/html; charset=us-ascii%22 http-equiv=%22Content-Type%22%3E%3Cstyle%3E%0Aa {%0A text-decoration: none;%0A color: #464feb;%0A}%0Atr th, tr td {%0A border: 1px solid #e6e6e6;%0A}%0Atr th {%0A background-color: #f5f5f5;%0A}%0A%3C/style%3E%3C/p%3E%3Cdiv style=%22font-family:%27Segoe UI%27;font-size:14px;font-style:normal;font-weight:400;line-height:20px;%22%3E%3Ci%3EThis is a contract position with an estimated end date in March 2028.%3C/i%3E%3C/div%3E%3Cp%3E%3Cspan style=%22font-family:Arial;%22%3E%3Cstrong%3EJOB SUMMARY%3C/strong%3E%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3ETo be a single point of contact, offering case management support services to plan members. Act as a resource to Pharmacies, and Patient Support Programs and continuous support for plan members for on‐going support with coverage, access to medications, and reimbursement navigation. This position reports into the Program Manager, Payor Solutions.%3C/span%3E%3Cbr%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E%3Cstrong%3EDUTIES AND RESPONSIBILITIES%3C/strong%3E%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Liaise and advocate with insurance companies, Patient Support Programs, physician’ offices and healthcare professionals to maximize reimbursement solutions%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Encourage plan member enrollment in the applicable Patient Support Program%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Completes and/or reviews Prior Authorization forms prior to submission to insurers, when the plan member is not enrolled within a Patient Support Program%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Maintain in depth knowledge of public, private, and federal funding mechanisms nationally for all program drugs.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Maintain detailed electronic notes in the plan member’s file%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Gather all pertinent and appropriate coverage information from the plan member or Patient Support Program to complete pharmacy referrals (Private and/or Public insurance, or financial assistance) in a concise, organized, and professional manner.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Proactively offer counseling, advocacy, and assistance for plan members.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Act as a central resource liaison for program stakeholders, which include private and public insurers, pharmacies, nurses, and Patient Support Programs.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Adjudicate prescriptions to external payers and support Bayshore Pharmacies with troubleshooting any adjudication error or reimbursement issues identified.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Communicates with plan members’ third-party plans to troubleshoot rejected claims.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Coordinate specialty pharmacy services once funding has been secured%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Provide updates to stakeholders as requested.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Potential for large amount of telephone support required.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Participate in ongoing internal and/or external continuing education activities.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Adhere to Bayshore Policies and Procedures.%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Participate in quality activities and continuous improvement initiatives in keeping with the company%27s Quality Management System as well as specific performance indicators for the project.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Participate in proactive Health %26amp; Safety activities while performing all duties. Is responsible to notify immediate Supervisor of any Health %26amp; Safety risks or concerns.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Maintains confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel.%26nbsp;%3C/span%3E%3Cbr%3E%3Cspan style=%22font-family:Arial;%22%3E• Complete other tasks as requested.%3C/span%3E%3C/p%3E | Oracle Taleo Enterprise | active | — | First seen 2026-06-17 Changed 2026-06-17 |
| Workers Compensation Claims Management Advocate | Esm | California, CA, United States | Claims Advocacy | BambooHR | active Full Time | — | Posted 2022-06-06 First seen 2026-05-30 Changed 2026-05-30 |
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