Insurance Specialist II

1 day ago

Chicago, Illinois, United States AbbVie Full time
Job Summary

We are seeking a highly skilled Insurance Specialist II to join our team at AbbVie. As a key member of our Access Support team, you will be responsible for providing exceptional customer service to healthcare providers and patients, addressing complex patient access challenges, and ensuring timely resolution of insurance-related issues.

Key Responsibilities
  • Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls, driving first call resolution and ensuring accurate explanations of patients' medical and/or pharmacy benefits, financial assistance, and access questions.
  • Investigate and problem-solve for patients experiencing escalated issues, such as disadvantaged or complex access, savings card/copay card challenges, or non-preferred formulary issues.
  • Quickly learn and execute business process and system changes for all drugs and channel sources as applicable, maintaining an understanding of current business procedures, deviations, and case processing for all brands and channel sources.
  • Accurately communicate insurance details to HCPs and patients via phone, other electronic communication methods, and fax, as per established policies and procedures.
  • Identify potential Adverse Event situations for reporting to Pharmacovigilance, ensuring AbbVie meets FDA regulations.
  • Support changing business priorities by being flexible in executing or overseeing completion of specific tasks to support the patients, products, or services we provide for all current and new products.
  • Work cross-functionally to identify and share opportunities for process and productivity improvements, liaising between healthcare providers, insurance companies, AbbVie Patient Access Support field reps, Ambassadors, filling pharmacies, and patients to administer the Patient Support Service programs.
  • Meet or exceed department standards relative to performance metrics, maintaining a work environment that upholds privacy standards required by law and AbbVie policy.
  • Act as a resource for the Training department, providing support for training curriculum and new hires, and providing side-by-side coaching and assistance for Insurance Specialist Level 1s.
Requirements
  • High school diploma or GED equivalent required; degree preferred.
  • 2-4 years of work experience in a healthcare or reimbursement setting; previous experience in a call center environment, healthcare office, or specialty pharmacy preferred.
  • Understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations preferred.
  • Experience and knowledge in Medicare Part D, Medicaid, and alternate funding resources, private payers, pharmacy benefits, and medical benefits preferred.
  • Demonstrated ability to lead and participate within a team, manage multiple priorities, and meet associated timelines while maintaining accuracy.
  • Professional written and verbal communication skills required.
  • Ability to maintain a positive service image at all times, even when dealing with challenging issues and unsatisfied customers.
  • Demonstrated strong, accurate technical skills, with a proven ability to learn and navigate computer systems.

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