You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Reimbursement Specialist responsible for conducting pharmacy benefit investigations to support patient access to prescribed therapies. This role involves working closely with insurance providers, medical offices, and internal teams to verify coverage, document accurate benefit details, and ensure cases are routed efficiently.

Key Responsibilities

• Conduct benefit investigations via test claims, electronic benefit verification (eBV), and outbound calls.
• Contact insurance providers to verify specialty pharmacy and prescription coverage.
• Update and maintain accurate patient records, including pharmacy processing information (BIN, PCN, ID, Group).
• Document detailed benefit results and routing information per established guidelines.
• Review referrals for completeness and accuracy; identify and communicate missing information.
• Route benefit findings to Case Managers and escalate urgent or complex issues.
• Monitor and follow up on prior authorization status as required.
• Identify, troubleshoot, and resolve system or data errors impacting benefit investigations.
• Maintain accurate and compliant documentation of all activities.

Qualifications

• 1-2 years of experience in pharmacy, insurance verification, or healthcare support environment.
• Hands-on experience with pharmacy benefit investigation and claims adjudication.
• Understanding of pharmacy claim processing (BIN, PCN, Group, ID).
• Data entry and system navigation skills (CRM or case management tools).
• High school diploma or GED.
• Preferred: Experience with specialty pharmacy or hub services.
• Preferred: Familiarity with electronic benefit verification (eBV) tools.
• Preferred: Knowledge of prior authorization processes.
• Preferred: Associate’s degree or certification in healthcare or pharmacy-related field.
• Preferred: Experience with call center telephony systems.

Skills

• Proficiency in pharmacy claim processing and benefit investigation.
• Strong data entry and system navigation skills.
• Attention to detail and ability to work in a fast-paced environment.

Additional Requirements

Must be flexible to work any 8-hour shift, Monday-Friday between 8am-8pm.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Medix is committed to compliance with all applicable federal, state, and local laws. Medix is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients