Insurance Verification Specialist -Remote (Michigan)
About the position Responsibilities • Respond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls. • Resolve questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. • Request and load PBM and/or Major Medical insurance plans. • Process all non-clinical PBM rejections, including rejections for plan limits, coverage termed, or prior authorization. • Assist physicians in the prior authorization process including initiation of prior authorizations. • Verify benefits for Major Medical via online resources or over the phone, confirming network status and reviewing FDA guidelines. • Facilitate the reimbursement windshields for PBM major medical claims. • Identify and assess individual customer or patient needs and provide education on grant applications and commercial copay assistance enrollment. • Provide primary support and expertise for specialized programs such as the patient assistance program. • Document contact interactions, recording details, complaints, comments, and actions taken. Requirements • High school diploma/GED • Experience providing customer service in healthcare, specialty pharmacy, PBM, or call center settings. • Ability to communicate clearly and effectively, both written and verbal. • Basic level PC skills, including MS Windows and MS Office Suite. Nice-to-haves • Experience with customer service related to adherence and complex disease states. • Experience in identifying operational issues and recommending strategies to resolve problems. • Intermediate level PC skills, including MS Windows and MS Office Suite. Benefits • Hourly rate between $16.50 to $22.00 based on experience and location. Apply tot his job