Overview
Join our dynamic team as a Benefits Investigation Specialist and be a crucial part of ensuring access to essential medications! We seek a compassionate individual to engage with Medical Insurance Payers and Pharmacy Benefit Managers, playing a vital role in identifying and documenting coverage options for retail and specialty medications.
Why work with us?
- Immerse yourself in an excellent company culture with fun events and volunteer opportunities.
- Enjoy competitive benefits, including medical, dental, vision, and more.
- Please take advantage of our 401k package with a dollar-for-dollar match-up.
- Generous PTO and paid holiday days are offered.
- Embrace opportunities for professional and personal growth in our team-oriented atmosphere.
Responsibilities
What you will do:
- Connect with Payers and Pharmacy Benefit Managers via outbound calls to verify patient insurance coverage and uncover available Medical and Pharmacy benefits.
- Communicate case details to relevant internal or external parties, fostering effective collaboration.
- Identify potential mechanisms for quick access to therapy by recognizing any payer coverage restrictions.
- Showcase your ability to contribute effectively, whether working independently or in small workgroups.
- Meet production and time completion goals with a focus on maintaining high-quality customer service standards in accordance with federal and state regulations.
- Accurately document payer Prior Authorization and Appeals protocols, ensuring meticulous attention to detail.
- Participate in special projects and embrace additional duties as required, contributing to a dynamic work environment.
- Maintain a comprehensive repository of payer or brand-specific coverage information.
- Engage in training and process improvement initiatives to enhance your professional growth.
Qualifications
What we need from you:
- A high school diploma or equivalent is required; a Bachelor's degree is preferred.
- Minimum of 2 years of experience in customer service, insurance, benefits, marketing, sales, or a related area is required, or a Bachelor's degree with one year of relevant experience.
- Preferred experience in a healthcare environment focusing on third-party benefits verification.
- Understanding of commercial insurance concepts, including coverage policies, major medical benefits, and knowledge of government and patient assistance programs.
- Highly proficient in computer skills, including Microsoft tools, working from dual monitors, etc.
- Strong email correspondence and personal documentation skills.
- Fundamental analytic and problem-solving skills with excellent time management.
- Demonstrated professional customer service experience with high attention to detail.
- Be a critical thinker who is adaptable and results-driven.
