Insurance Reimbursement Specialist

Job Description

Location: Pittsburgh, PA (Hybrid)

We are seeking an Insurance Reimbursement Specialist to support insurance reimbursement, payer communications, and patient access activities within a specialty healthcare environment. This is a full-time, direct hire opportunity. This role is responsible for researching insurance benefits, resolving coverage and reimbursement challenges, and coordinating with insurance carriers, provider offices, pharmacies, patients, and internal teams to support timely case progression.

This position is ideal for a healthcare professional with experience navigating insurance requirements, researching coverage issues, and resolving reimbursement challenges across the healthcare continuum. The ideal candidate is comfortable communicating with payers, healthcare providers, pharmacies, and patients, managing multiple cases simultaneously, and working collaboratively to remove barriers that may delay patient care while delivering a high level of customer service.

Responsibilities:

• Manage assigned reimbursement cases from initial referral through coverage determination and case resolution
• Verify insurance benefits, eligibility, and coverage requirements across commercial and government health plans
• Coordinate authorization, reimbursement, and insurance support activities to help facilitate timely patient care
• Communicate with insurance carriers, provider offices, pharmacies, patients, and internal teams regarding case status and coverage requirements
• Research payer policies and identify solutions to resolve reimbursement and coverage issues
• Review clinical and insurance documentation to ensure payer requirements are met before case progression
• Maintain accurate documentation of all case activity within internal case management systems
• Monitor payer policy updates, coverage requirements, and reimbursement guidelines affecting assigned cases
• Escalate complex reimbursement issues while collaborating with internal stakeholders to achieve timely resolution
• Support financial assistance and patient support program activities in accordance with organizational guidelines
• Maintain compliance with HIPAA, payer requirements, and organizational quality standards

Qualifications:

• High school diploma required; Associate’s or Bachelor’s degree in Healthcare, Business, or a related field preferred
• Minimum of 2 years of experience in healthcare reimbursement, insurance verification, patient access, medical billing, or related healthcare operations
• Experience working with insurance carriers, provider offices, pharmacies, or healthcare support teams
• General knowledge of insurance benefits, coverage requirements, authorizations, and reimbursement processes
• Experience using healthcare software, case management platforms, CRM systems, or electronic documentation tools preferred
• Strong analytical and problem-solving skills with the ability to research and resolve complex coverage issues
• Strong organizational skills with the ability to manage multiple cases, deadlines, and competing priorities
• Excellent written and verbal communication skills with a professional, service-oriented approach

Schedule:

• Hourly, Full-time position
• Remote schedule following the successful completion of initial training
• Monday through Friday, with scheduled shifts between 8:00 AM and 8:00 PM EST
• Standard full-time schedule of 40 hours per week
• Company-issued equipment provided

Salary Range:

The salary range for this position is approximately $45,000 – $60,000 annually ($21.63 – $28.85 per hour), based on experience and qualifications.

Interview Process:

Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.