Ben Investigation Spec-Hub Svcs

4 weeks ago

Pittsburgh, United States ConnectiveRx Full time

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.

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