Bilingual Document Specialist supporting a positive customer experience in Group Benefits Administration at Sun Life by processing documents and managing inquiries.
About the role
- Senior Caseworker providing reimbursement support for patients in medical settings. Bilingual in French and English, managing complex insurance and reimbursement tasks with a focus on patient assistance.
Responsibilities
- Working closely with assigned patients’ to identify various reimbursement coverage options and investigate financial options for those without insurance.
- Assist with the coaching and mentoring of existing team members.
- Manage a patient caseload larger than their caseworker counterparts.
- Be a reimbursement expert in assigned caseload territory.
- Provides other caseworker(s) assistance with complex reimbursement, insurance, benefit investigation, special authorization, and appeal requests.
- Participate in special projects as assigned by the Program Manager.
- Provide daily support to Associate Program Manager(s)
- Assist management with various reports and program related tasks.
- Work with management to develop program protocol and SOP for Caseworker role.
- With management, lead training of new caseworkers, including but not limited to shadowing & call monitoring.
- Regularly Interacts with insurance companies, physician' offices, and healthcare professionals to provide optimal reimbursement support
- Assists the patient with Clinic and Pharmacy selections, and schedules patient appointments
- Generates drug orders ensuring that required information is faxed to the pharmacy, and related parties
- Adherence to the general company processes.
- Implementing call-centre programs including the provision of patient, healthcare professional and funding bodies with telephone support. Current assistance lines focus on: Funding and access issues, including private, public and special access programs; Compliance programs
- Administer and adhere to case-management protocols, including clinical monitoring, data collection, ongoing patient follow-up, compliance, therapy disruption/discontinuation monitoring, adverse event reporting and liaison with primary healthcare providers; Implementing pharmaceutical and biotechnology related market research initiatives with physicians, patients, pharmacists or other allied health professionals; All patient programs are based on casework methods and include a significant amount of out-bound calls.
- Document each activity in program specific database.
- Participate and attend ongoing refresher training and in specialized training courses for specific products or programs as deemed appropriate by the manager.
- Clear communication to manager, pod, and program trained colleagues regarding the management of cases during foreseen absences.
- Responsible to report all Adverse Events to the assigned units/departments
Requirements
- A minimum of two (2) years experience in customer service; experience in medical, pharmaceutical and/or insurance industry is an asset
- Bilingual in French and English: written and verbal is an asset
- Highly organized with strong attention to detail
- Strong proficiency in Microsoft applications (Outlook, Word, Excel & PowerPoint)
- Flexibility in working shifts (hours of operation are 8 am - 8pm)
- Ability to apply critical thinking skills in order to solution problems
- A Minimum of 2 years experience working for a patient support program
- Experience working in a call center environment an asset
- Strong communication and interpersonal skills: written and verbal including effective phone etiquette to diverse audiences i.e. internal, healthcare professionals and patients
- Proven ability to manage time, set priorities and multi-task in order to meet various competing work deadlines
- Minimum University Degree in a related field or equivalent
Benefits
- medical, dental, and vision care
- comprehensive suite of benefits
- support for working families
- backup dependent care
- adoption assistance
- infertility coverage
- family building support
- behavioral health solutions
- paid parental leave
- paid caregiver leave
- variety of training programs
- professional development resources
- mentorship programs
- employee resource groups
- volunteer activities
- inclusive culture
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