Benefit Investigation Specialist - Extern

ConnectiveRx • Pittsburgh, PA

7d

About The Position

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 Payer and Pharmacy Benefit Managers, playing a vital role in identifying and documenting coverage options for retail and specialty medications.

Requirements

• A high school diploma or equivalent is required.
• 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.
• 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.

Nice To Haves

• A Bachelor's degree is preferred.
• Preferred experience in a healthcare environment focusing on third-party benefits verification.

Responsibilities

• 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.

Benefits

• medical
• dental
• vision
• life
• disability insurance
• 401(k) plan
• paid time off (PTO)
• sick time off (STO)
• eight standard company holidays
• three floating holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED