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Insurance Benefits Specialist

2 months ago

Fresno, California, United States TEKsystems Full time

Position Overview:

The Insurance Benefits Specialist will engage with insurance providers on behalf of healthcare practitioners to confirm patient-specific coverage details. This role involves posing relevant inquiries about patient benefits and accurately documenting the findings through data entry and required forms.


Key Responsibilities:

  • Gather and assess all necessary patient insurance information to facilitate the benefits verification process.
  • Confirm patient-specific benefits and meticulously record details for various payer plans, including coverage specifics, cost-sharing, and access/provider options in accordance with established Standard Operating Procedures (SOPs).
  • The verification process may involve electronic validation of pharmacy coverage and medical eligibility.
  • Identify any limitations and provide guidance on expediting patient access.
  • May include initiating the prior authorization process, claims appeals, and other related tasks.
  • Conduct quality reviews of work to ensure accuracy and completeness.
  • Report any reimbursement trends or delays to the supervisor.
  • Perform additional duties and special projects as assigned.


Work Environment:

This position requires the ability to thrive in a dynamic office setting, demonstrating focus, adaptability, and flexibility in response to changing work situations. The role necessitates prolonged periods of seated work.


Qualifications:

  • A minimum of a high school diploma or GED is required, with two or more years of relevant experience preferred, or a college degree.
  • Experience in medical office administration, benefits verification, coding, claims processing, or customer service within an insurance company is advantageous.
  • Broader experience in fields such as case management, social services, or pharmacy technician roles may also be considered.
  • Familiarity with insurance benefits verification is a plus.
  • A fundamental understanding of key payers, including Medicaid, Medicare, and private insurers, is essential.
  • Strong customer service skills are required.


Experience Level:

Expert Level

Eligibility for certain benefits may depend on job classification and length of employment. Benefits are subject to change and may be contingent upon specific elections, plans, or program terms.


About TEKsystems:

At TEKsystems, we are partners in transformation, assisting clients in activating innovative ideas and solutions to leverage new opportunities. Our team of 80,000 professionals collaborates with over 6,000 clients, including a significant portion of the Fortune 500, across North America, Europe, and Asia. As a leader in Full-Stack Technology Services and Talent Services, we work alongside progressive leaders to drive meaningful change. This is the essence of true partnership. TEKsystems is part of the Allegis Group.


The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information, or any characteristic protected by law.