Insurance Specialist

At Pixel, we’re on a mission to connect a fragmented healthcare system through a unified fertility management and support platform. We bring patients, providers, and pharmacies together, so information flows freely, questions are answered, and treatment is supported every step of the way.

We believe patients deserve more than prescriptions — they deserve guidance, education, and compassionate support throughout their fertility journey. That’s why we’re building a platform that empowers patients while connecting them with the healthcare professionals, resources, and community they need to feel informed and supported.

We’re looking for a detail-oriented, resourceful Insurance Specialist to help patients navigate the often-complex insurance and medication access process. This is a full-time, on‑site position based at Pixel’s satellite location in Cedar Knolls, NJ with a Monday through Friday schedule, 9 am to 5:30 pm.

In this role, you’ll conduct comprehensive benefits analysis, perform and manage prior authorizations, investigate rejected pharmacy claims, and help identify available coverage and patient financial assistance opportunities. Working across payer portals, pharmacy systems, and other resources, you’ll help patients better understand their benefits and the steps required to access prescribed medications.

You’ll take an active role in swiftly moving insurance‑related needs forward by following prior authorizations through completion, investigating coverage barriers, coordinating with patients, providers, and internal care teams, and proactively reaching out when direct communication can help clarify information or advance medication access.

At Pixel, patient‑first care means making a complicated healthcare journey feel more informed, connected, and supported. As an important part of our patient care operations, you’ll help reduce uncertainty, remove insurance‑related barriers, and ensure patients understand what comes next.

The ideal candidate is highly organized, detail‑oriented, and naturally persistent when working through complex insurance questions. They are comfortable navigating multiple systems, asking questions, following up, and taking ownership of issues through resolution. They communicate with empathy and professionalism, work well across teams, and understand that timely, proactive outreach can make a meaningful difference in a patient’s ability to access treatment.

• Conduct comprehensive benefits analysis, including pharmacy and medical benefits, deductibles, copays, coinsurance, out‑of‑pocket responsibility, coverage limitations, exclusions, and applicable lifetime maximums.
• Perform and manage prior authorizations and pre‑certifications for prescribed medications, including submission, follow‑up, status tracking, and coordination of required supporting information.
• Review payer requirements and established authorization criteria to identify the information and documentation necessary to complete prior authorization requests.
• Investigate rejected or failed pharmacy claims and help resolve coverage restrictions, refill limitations, network requirements, and other insurance‑related barriers.
• Identify insurance‑preferred or mandated specialty pharmacies and coordinate appropriate routing when required by a patient’s plan.
• Identify and verify available manufacturer programs, copay assistance, discounts, and other patient financial assistance opportunities.
• Coordinate with patients, providers, referring clinics, pharmacists, and payer representatives to obtain insurance information, medical records, pharmacy benefit details, and other required documentation.
• Monitor prior authorizations through completion and proactively follow up on pending, incomplete, denied, or unresolved requests.
• Assist with authorization denials and appeals by gathering and routing required documentation to the appropriate clinical or operational team members.
• Provide patients with clear and accurate information regarding insurance coverage, estimated out‑of‑pocket responsibility, authorization status, and medication‑access requirements.
• Proactively reach out to patients by phone or…