[Remote] Remote Insurance Verification Specialist, Specialty (Pennsylvania)

Note: The job is a remote job and is open to candidates in USA. Walgreens is a well-established company serving nearly 9 million customers daily. They are seeking an Insurance Verification Specialist responsible for verifying patient eligibility, coordinating benefits, and handling customer inquiries regarding insurance coverage and services.ResponsibilitiesRespond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone callsResolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes all available information to choose the best solution and resolve customer and PBM concernsRequests and loads PBM and/or Major Medical insurance plansProcesses all non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorizationAssists physicians in the prior authorization process including initiation of prior authorizationsMay be cross-trained and/or work on Major Medical (MM) and Specialized PBM PlansVerifies benefits for Major Medical via online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claimsResolves questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilizes all available information to choose best solutions and resolves customer and plan coversFacilitates the reimbursement windshields for PBM major medical claimsIdentifies and assesses individual customer or patient needs and provide education on or assist with grant applications, complex funding needs, commercial copay assistance enrollment along with appropriate action to satisfy those needsProvides primary support and expertise for specialized programs such as the patient assistance program or special handlingManages Pharma requirements including but not limited to warm transfers, bridge/quick start, enhanced prior authorization and appeal supportMay administer order queue such as Submission Problems or Waiting for PaymentDocuments contact interactions, records details, complaints, comments, and actions takenSkillsHigh school diploma/GEDExperience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in healthcare, specialty pharmacy, PBM, call center setting or other related industryAbility to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential mannerBasic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line)Experience with providing customer service related to adherence, complex disease states quality, After Call Work (ACW), etcExperience in identifying operational issues and recommending and implementing strategies to resolve problemsIntermediate level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line)Company OverviewWalgreens is a pharmacy, health, and wellness service center that offers trained infusion nurses and pharmacists to treat patients. It is a sub-organization of Walgreens Boots Alliance. It was founded in 1901, and is headquartered in Deerfield, Illinois, USA, with a workforce of 10001+ employees. Its website is https://www.walgreens.com.Company H1B SponsorshipWalgreens has a track record of offering H1B sponsorships, with 1 in 2022. Please note that this does not guarantee sponsorship for this specific role.