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Program Specialist II

Company Description

At EVERSANA, we are proud to be certified as a Great Place to Work across the globe. We’re fueled by our vision to create a healthier world. How? Our global team of more than 7,000 employees is committed to creating and delivering next-generation commercialization services to the life sciences industry. We are grounded in our cultural beliefs and serve more than 650 clients ranging from innovative biotech start-ups to established pharmaceutical companies. Our products, services and solutions help bring innovative therapies to market and support the patients who depend on them. Our jobs, skills and talents are unique, but together we make an impact every day. Join us!

Across our growing organization, we embrace diversity in backgrounds and experiences. Improving patient lives around the world is a priority, and we need people from all backgrounds and swaths of life to help build the future of the healthcare and the life sciences industry. We believe our people make all the difference in cultivating an inclusive culture that embraces our cultural beliefs.  We are deliberate and self-reflective about the kind of team and culture we are building. We look for team members that are not only strong in their own aptitudes but also who care deeply about EVERSANA, our people, clients and most importantly, the patients we serve.   We are EVERSANA.  

Job Description

THE POSITION:
The Program Specialist II will provide dedicated support to patients and doctors for activities related to benefit coverage, payments, reimbursements, denials and general inquiry phone calls through our patient services support center.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Our employees are tasked with delivering excellent business results through the efforts of their teams.  These results are achieved by:

  • Provide dedicated, personalized support delivered over the phone and via online portal.
  • Complete investigations and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs. Collaborate with patients and doctors to assist with issues related to payments, reimbursements, payment denials, and appeals.   Make outbound calls to customers for additional information.
  • Assist with prior authorization and medical necessity processes, benefit verification and prior authorization assistance.
  • Administer comprehensive searches for alternate reimbursement resources, such as state and federal assistance programs, and enrollment assistance for qualified patients.
  • Respond to inquiries from customers, sales representatives and business partners, and follow up on requests in a timely, courteous and professional manner. Maintain positive attitude and a helpful approach to customers and clients.
  • Enter orders, change orders, track shipments, and enter customer notes to complete customer/consumer transactions. To include maintaining logs and records as required.
  • Process patient assistance applications according to business rules of program.
  • Other tasks and projects as assigned

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

EXPECTATIONS OF THE JOB:

  • Assist with benefit verifications and prior authorizations
  • Enter orders, change orders, and enter customer notes to complete customer/consumer transactions.  To include maintaining logs and records as required.
  • Act as the primary point of contact for healthcare providers to obtain complete patient enrollment and insurance information
  • Learn, understand and follow all company and client policies and procedures.
  • Focus on results in a professional, ethical, and responsible manner when dealing with customers, vendors, team members, and others.
  • Accept being accountable and responsible in work practices and expectations. Delivers what is promised.
  • Foster a collaborative, team-oriented attitude. Communicates effectively with others with clarity and transparency.
  • Use innovative critical and creative thinking to evaluate and solve work and customer issues.
  • Seek assistance in solving work problems through collaboration and information seeking.
  • Excellent attendance

The above list reflects the general details necessary to describe the expectations of the position and shall not be construed as the only expectations that may be assigned for the position.

An individual in this position must be able to successfully perform the expectations listed above.

    Qualifications

    MINIMUM KNOWLEDGE, SKILLS AND ABILITIES:

    The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.

    • High School Diploma and 4 years’ experience or Associate’s Degree and 2 years’ experience in healthcare setting
    • Excellent oral, written, and interpersonal communication skills.
    • Ability to multi task.
    • Positive attitude.
    • Accurate and detail-orientated.
    • Ability to work independently and function as a team player.
    • Ability to work in a fast paced, metric driven environment, while remaining patient minded.
    • Strong computer skills with a working knowledge of Microsoft Word, Excel, and PowerPoint.

    PREFERRED QUALIFICATIONS:

    • Customer service and/or call center experience
    • Patient assistance, reimbursement and/or pharmacy benefit management experience
    • Medical billing and coding experience

    #INP

    Additional Information

    OUR CULTURAL BELIEFS:

    Patient Minded I act with the patient’s best interest in mind.

    Client Delight I own every client experience and its impact on results.

    Take Action I am empowered and empower others to act now.

    Grow Talent I own my development and invest in the development of others. 

    Win Together I passionately connect with anyone, anywhere, anytime to achieve results.

    Communication Matters I speak up to create transparent, thoughtful and timely dialogue.

    Embrace Diversity I create an environment of awareness and respect.

    Always Innovate I am bold and creative in everything I do.

    EVERSANA is committed to providing competitive salaries and benefits for all employees. The anticipated base salary range for this position is $15.39/hr to $23.08/hr and is not applicable to locations outside of the U.S.  The base salary range represents the low and high end of the salary range for this position.  Compensation will be determined based on relevant experience, other job-related qualifications/skills, and geographic location (to account for comparative cost of living).  More information about EVERSANA’s benefits package can be found at eversana.com/careers.  EVERSANA reserves the right to modify this base salary range and benefits at any time.

    Our team is aware of recent fraudulent job offers in the market, misrepresenting EVERSANA. Recruitment fraud is a sophisticated scam commonly perpetrated through online services using fake websites, unsolicited e-mails, or even text messages claiming to be a legitimate company. Some of these scams request personal information and even payment for training or job application fees. Please know EVERSANA would never require personal information nor payment of any kind during the employment process. We respect the personal rights of all candidates looking to explore careers at EVERSANA.

    From EVERSANA’s inception, Diversity, Equity & Inclusion have always been key to our success. We are an Equal Opportunity Employer, and our employees are people with different strengths, experiences, and backgrounds who share a passion for improving the lives of patients and leading innovation within the healthcare industry. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion, and many other parts of one’s identity. All of our employees’ points of view are key to our success, and inclusion is everyone's responsibility.

    Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of EVERSANA to provide reasonable accommodation when requested by a qualified applicant or candidate with a disability, unless such accommodation would cause an undue hardship for EVERSANA. The policy regarding requests for reasonable accommodations applies to all aspects of the hiring process. If reasonable accommodation is needed to participate in the interview and hiring process, please contact us at [email protected].

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    Average salary estimate

    $40000 / YEARLY (est.)
    min
    max
    $32000K
    $48000K

    If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.

    What You Should Know About Program Specialist II, EVERSANA

    As a Program Specialist II at EVERSANA in Chesterfield, MO, you’ll take on an essential role within our dedicated patient services support center. We pride ourselves on creating a healthier world, and you’ll be at the forefront of this mission by directly assisting patients and healthcare providers with insurance-related queries and issues. Your day-to-day responsibilities will include navigating benefit coverage, handling inquiries about payments and reimbursements, and helping to simplify the often-complicated healthcare processes. You will provide personalized, empathetic support over the phone and through our online portal, ensuring that patients feel cared for and understood. With your strong communication skills and detail-oriented mindset, you will collaborate with diverse stakeholders to clarify benefits, assist with prior authorizations, and explore alternative reimbursement resources. You will play a crucial role in not just problem-solving, but also in building positive relationships with patients and clients, contributing to EVERSANA's commitment to client delight. This position offers the opportunity to work in a dynamic team, all while maintaining a patient-centered focus. If you’re someone who thrives in a fast-paced setting and is passionate about making a difference in the healthcare industry, we invite you to join us at EVERSANA!

    Frequently Asked Questions (FAQs) for Program Specialist II Role at EVERSANA
    What responsibilities does the Program Specialist II role at EVERSANA entail?

    The Program Specialist II at EVERSANA handles a variety of responsibilities including providing dedicated support to patients and healthcare providers, investigating insurance benefits, and assisting with prior authorizations. Your role will involve making outbound calls for additional information and collaborating on payment-related issues. Additionally, you will manage customer inquiries in a professional manner and maintain accurate records of transactions.

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    What qualifications are required for the Program Specialist II position at EVERSANA?

    To qualify for the Program Specialist II position at EVERSANA, candidates should possess a high school diploma with four years of relevant experience or an associate’s degree with two years in a healthcare setting. Strong communication skills, the ability to multitask, and a positive attitude are essential, along with proficiency in Microsoft Office applications.

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    Is customer service experience important for the Program Specialist II role at EVERSANA?

    Yes, customer service experience is highly beneficial for the Program Specialist II position at EVERSANA. The role involves engaging with patients and healthcare providers through various channels, so having a background in customer service can enhance communication skills and contribute to a positive experience for those you assist.

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    What are the growth opportunities for a Program Specialist II at EVERSANA?

    At EVERSANA, the Program Specialist II position serves as a vital role with various growth opportunities. Employees are encouraged to develop their skills and pursue career advancement within the organization. There is a strong focus on employee development, offering paths towards roles in healthcare administration or more specialized areas in patient services.

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    What is the company culture like at EVERSANA for a Program Specialist II?

    The culture at EVERSANA is centered around inclusivity, collaboration, and a patient-focused mindset. As a Program Specialist II, you will be part of a supportive team that values diverse experiences and backgrounds. The company emphasizes its core beliefs of 'Win Together' and 'Always Innovate', creating an environment where everyone is encouraged to contribute to both personal and organizational success.

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    Common Interview Questions for Program Specialist II
    Can you describe your experience in handling insurance inquiries as a Program Specialist II?

    When answering this question, highlight specific examples from your past experiences where you successfully resolved insurance inquiries. Discuss the types of claims you handled, any tools or software you used, and how you maintained communication with the patient or healthcare provider.

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    How do you prioritize tasks when managing multiple patients' inquiries?

    Share your method for prioritizing tasks, perhaps by using tools like lists or management software. Discuss how patient urgency, complexity of the issue, or deadlines help you decide which tasks need immediate attention, showcasing your ability to work efficiently under pressure.

    Join Rise to see the full answer
    What strategies do you use to provide excellent customer service?

    Discuss your approach to delivering excellent customer service, emphasizing empathy, active listening, and clear communication. Share a personal story that illustrates your commitment to client satisfaction and how you handle difficult situations successfully.

    Join Rise to see the full answer
    How do you keep updated with policies and procedures in the healthcare sector?

    Mention your methods for staying informed about healthcare policies and changes, such as subscribing to industry newsletters, attending workshops, or engaging in continuing education. Show that you value knowledge, which is crucial in a dynamic field like healthcare.

    Join Rise to see the full answer
    How would you handle a situation where a patient is frustrated about their coverage?

    Explain how you would remain calm, listen actively to the patient's concerns, and empathize with their situation. Discuss steps to gather necessary information and work collaboratively to find a solution, demonstrating your ability to maintain professionalism under stress.

    Join Rise to see the full answer
    Describe a time when you worked as part of a team to achieve a common goal.

    Provide an example of a team project you were involved in, detailing your role, your contributions, and the outcome. Highlight the importance of teamwork and how collaboration helped in reaching the goal, aligning with EVERSANA’s belief in winning together.

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    What tools and software have you used in prior roles related to healthcare support?

    List relevant tools and software you’ve previously used, such as Electronic Health Records (EHR) systems, CRM platforms, or specific patient management software. Explain how you used these tools to streamline processes and improve patient service.

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    Can you explain any experience you have with prior authorization processes?

    Discuss your understanding of prior authorization and any hands-on experience you have. Share a specific instance where you successfully navigated the process for a patient or client, emphasizing attention to detail and adherence to required protocols.

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    How do you ensure accuracy in your work, especially with patient data?

    Talk about the importance of thoroughness in handling patient data and the methods you use to double-check information, such as reviewing entries or maintaining organized records. Provide examples that showcase your commitment to accuracy.

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    What motivates you to work in the healthcare sector as a Program Specialist II?

    Express your passion for healthcare and helping others. Share what drives you to work in this field, such as personal experiences with healthcare or a desire to support patients in navigating their healthcare journey. This personal touch adds depth to your candidacy.

    Join Rise to see the full answer
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    A Vision to Advance Life Sciences Services “Sana” is latin for healthy. So naturally, when service leaders – spanning the patient experience to global channel distribution – combined into one powerful platform, we became EVERSANA. Together, we w...

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    DATE POSTED
    March 15, 2025

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