Insurance Verification Specialist -Remote (Michigan)

About the position

The Insurance Verification Specialist is responsible for verifying patient eligibility, coordinating benefits, and determining patient coverage for services. This fully remote position requires the individual to reside in Michigan and involves handling inbound and outbound calls with customers, physician offices, and third-party providers, ensuring efficient and courteous service while following standard operating procedures.

Responsibilities

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  Respond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls.
  
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  Resolve questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures.
  
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  Request and load PBM and/or Major Medical insurance plans.
  
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  Process all non-clinical PBM rejections, including rejections for plan limits, coverage termed, or prior authorization.
  
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  Assist physicians in the prior authorization process including initiation of prior authorizations.
  
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  Verify benefits for Major Medical via online resources or over the phone, confirming network status and reviewing FDA guidelines.
  
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  Facilitate the reimbursement windshields for PBM major medical claims.
  
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  Identify and assess individual customer or patient needs and provide education on grant applications and commercial copay assistance enrollment.
  
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  Provide primary support and expertise for specialized programs such as the patient assistance program.
  
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  Document contact interactions, recording details, complaints, comments, and actions taken.
  

Requirements

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  High school diploma/GED
  
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  Experience providing customer service in healthcare, specialty pharmacy, PBM, or call center settings.
  
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  Ability to communicate clearly and effectively, both written and verbal.
  
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  Basic level PC skills, including MS Windows and MS Office Suite.
  

Nice-to-haves

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  Experience with customer service related to adherence and complex disease states.
  
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  Experience in identifying operational issues and recommending strategies to resolve problems.
  
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  Intermediate level PC skills, including MS Windows and MS Office Suite.
  

Benefits

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  Hourly rate between $16.50 to $22.00 based on experience and location.
  

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