Case Manager

TEKsystems

. Provide expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers, and clients .

Posted 11/4/2026contractRemote • Texas • United StatesJuniorMid-Level💰 $23 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in insurance coverage, patient access, and reimbursement processes while maintaining compliance with HIPAA and industry standards. Proficient in educating healthcare providers and patients on benefits, program eligibility, and navigating payer processes.

Highest-signal resume keywords

Healthcare Access DeliveryInsurance ReimbursementPatient EducationMedical TerminologyHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance ProcessesCoding SystemsICD-10CPTHCPCSBenefits InvestigationCase ManagementPatient AccessReimbursement ChallengesProgram-Specific Operating Procedures

Soft Skills

Relationship BuildingCommunicationProblem SolvingPatient AdvocacyCollaboration

Certifications & Qualifications

PACSCHESCCM

Industry Keywords

Healthcare AdministrationSocial SciencePatient CareComplianceInsurance Guidelines

About the role

Key responsibilities & impact

Provide expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers, and clients
Educate patients, healthcare providers, and clients on Valeris access and reimbursement support tools and participating programs
Advise HCPs, patients, and caregivers on benefits and program eligibility for specific patients
Educate HCP offices on payer processes and procedures
Build trusted relationships with patients, prescribers, and client stakeholders regarding reimbursement inquiries and challenges
Manage relationships in compliance with applicable laws, regulations, operating procedures, industry standards, HIPAA, and insurance guidelines
Support inbound and outbound calls to patients, caregivers, specialty pharmacies, and healthcare professionals
Perform post-Benefits Investigation calls explaining coverage options and next steps
Manage client inquiries, including case-specific statuses
Manage HCP inquiries according to business rules
Maintain compliant communications with client field teams under agreed ways-of-working protocols
Manage inbound calls using program-approved FAQs
Triage patients to internal or external resources as appropriate
Provide personalized case management and outbound communications to HCPs, specialty pharmacies, and patients

Requirements

What you’ll need

Completion of Bachelor's degree (or higher) required
A degree in healthcare administration, social science or similar related fields is strongly preferred
Minimum two years of experience in healthcare access delivery or management is strongly preferred
5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree
Other certifications and five or more consecutive years of experience in a relevant field may be considered
Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager)
Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes
Knowledge of HIPAA and insurance guidelines
Ability to support inbound and outbound calls with patients, caregivers, specialty pharmacies, and healthcare professionals
Ability to follow program-specific operating procedures, business rules, and industry standards

Benefits

Comp & perks

Medical, dental & vision
Critical Illness, Accident, and Hospital coverage
401(k) Retirement Plan with pre-tax and Roth post-tax contributions
Life Insurance (Voluntary Life & AD&D for the employee and dependents)
Short and long-term disability
Health Spending Account (HSA)
Transportation benefits
Employee Assistance Program
Time Off/Leave (PTO, Vacation or Sick Leave)