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Healthcare Call Center Specialist

0-2 years
Not Disclosed
10 April 29, 2025
Job Description
Job Type: Full Time Education: B.Sc./M.Sc/B.Pharm/M.Pharm/Life Science Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

 

Job Title:

Healthcare Call Center Specialist


Company:

EVERSANA
Location: Mason, Ohio, USA
Department: Patient Services – Customer Service & Engagement
Job Type: Full-Time


About the Company:

EVERSANA is a leading global provider of commercialization services to the life sciences industry, with over 7,000 employees and 650+ clients worldwide. The company is focused on patient outcomes, innovation, and creating an inclusive culture grounded in shared values and diversity.


Job Summary:

The Healthcare Call Center Specialist supports patients, healthcare providers (HCPs), and payers by managing inquiries related to insurance coverage, benefit verification, claim denials, prior authorizations, and appeals. The specialist serves as a primary point of contact to ensure patients receive timely, accurate support regarding access to therapy.


Key Responsibilities:

Patient & Provider Support

  • Respond to inquiries via phone, CRM, and email

  • Conduct benefit investigations and explain coverage and cost details

  • Provide support with prior authorizations and appeal processes

Triage & Workflow Management

  • Identify and forward cases to third-party support centers when appropriate

  • Intake and process patient enrollment inquiries

  • Ensure accurate data entry and documentation in support systems

Team & Process Improvement

  • Participate in training and quality improvement initiatives

  • Maintain a positive, patient-focused approach

  • Collaborate effectively with internal and external stakeholders


Job Expectations:

  • Work Monday–Friday on rotating 8-hour shifts

  • Maintain excellent attendance and adherence to procedures

  • Handle patient issues ethically and responsibly

  • Foster team collaboration and transparent communication

  • Apply critical thinking for problem-solving and escalation


Minimum Qualifications:

  • Strong pharmacy reimbursement knowledge, including prior authorization procedures

  • Experience in benefit verification, particularly with retail prescription drug products

  • Understanding of healthcare administration, billing, and reimbursement regulations

  • Proficiency in Microsoft Word, Excel, and PowerPoint

  • Excellent verbal and written communication skills

  • Detail-oriented with strong multitasking capabilities


Preferred Qualifications:

  • Experience in customer service or contact center roles

  • Familiarity with reimbursement or patient support services

  • Knowledge of retail pharmacy operations


Work Environment:

  • Office-based role with frequent sitting, phone use, and computer work

  • Occasional lifting up to 25 pounds

  • Moderate noise level and frequent interruptions