Reimbursement Specialist - 12 Month Contract - Express Scripts Canada

Location: Mississauga
Employment Type:  12 Month Contract Full-time

Reason for Vacancy: Backfill

Work Arrangement: Hybrid

Department Name: Advocate Services

Pay Typed: Hourly

Pay Range: $28 - $35

Please note that this is a general posting range and offer range will be varied based on relevant experience, qualifications, skills required and location for this role.

About Us

Express Scripts Canada (ESC) is a leading health benefits management company. Serving over 12 million members, we help insurance carriers, third party administrators, and the public sector optimize the value of health benefits by linking the talent and professional expertise of our people with leading edge information management systems and technology. ESC is a wholly owned subsidiary of Express Scripts Inc., one of the largest pharmacy benefit management (PBM) companies in North America, part of The Cigna Group (NYSE: CI), a global health company. Together, we deliver innovative, cost-effective solutions that improve access, affordability, and health outcomes for Canadians.

Job Summary

The Reimbursement Specialist assumes responsibility for managing reimbursement related issues for patients requiring specialty medications. This role will act as the patient advocate and work closely with patients to navigate and secure potential sources of reimbursement. Together with the pharmacy services, this role will bring more convenience, lower spend, and better health outcomes to patients.

Key Responsibilities

• Determine operational processes, and lead internal and external teams in implementation of program launch and ongoing utilization through assigned and self-initiated “pull through” efforts.

• Drive continual process improvements to enhance work efficiencies and optimize member experience. Provide training to internal team members as required.

• Manage case-by-case reimbursement for patients requiring specialty medications. Gather all pertinent information, coordinate patient cases, manage applications and work directly with the private, public, or manufacturer-sponsored drug funding programs to optimize reimbursement.

• Communicate and educate patients regarding their private drug coverage and options, including status of Prior Authorization requests.

• Identify and resolve reimbursement issues to facilitate pharmacy processes including prescription processing and invoicing.

• Identify gaps and opportunities for clinical education and healthcare support, and liaise with the appropriate internal teams or external organizations to provide and enhance patient care.

• Maintain and manage standard operating procedures and specialty medication funding program database.

• Develop and maintain relationships with private/public payers, manufacturers and plan sponsors. Apply knowledge and insights to enhance Specialty Pharmacy service offerings.

Qualifications:

• Bachelor’s Degree preferred

• 3-5 years of experience in the pharmacy benefit management, insurance, pharmacy, biotechnology, or pharmaceutical industries; customer service and/or reimbursement.

• Demonstrated commitment to improve patient care

• Able to work independently and within a team

• Excellent written/verbal communication to include providing clear instructions

• Ability to multitask

• Strong problem-solving skills with the ability to resolve issues effectively and efficiently

• Knowledge of the private or public drug reimbursement would be an asset

• Knowledge of pharmacy dispensing software is preferred

• Computer proficiency in MS Office applications, with database experience a plus

Why Join Us

• Competitive compensation, benefits and pension plan

• Career development and advancement opportunities

• A culture that celebrates innovation and collaboration

• Flexible work options and wellness programs

Pre-Employment Requirements

All offers of employment are conditional upon the successful completion of reference checks and background verification in accordance with company policy. Within ESC, for certain positions, obtaining and maintaining a federal government security clearance is a bona fide occupational requirement. Candidates applying for such roles must meet all eligibility criteria for the applicable clearance level and consent to the security screening process as mandated by federal regulations. Failure to obtain or maintain the required clearance will result in withdrawal of the offer or termination of employment.

Our hiring process includes AI-powered tools to conduct video interviews, take notes and score candidates; however, all scores will be reviewed by hiring managers and our Talent team before making a decision.

INTERNAL APPLICATION DEADLINE: FEBRUARY 16, 2026