Insurance Verification Specialist - Level 2 (Conversion)

Entry Level

The Insurance Verification Specialist - Level 2 is responsible for verifying patient eligibility, coordinating benefits, running test claims and determining patient coverage/responsibility for services.

• Process all non-clinical PBM rejections
• Respond to basic inbound PBM and PBM-related insurance phone calls and inquiries
• Facilitate reimbursement windshields for PBM claims
• May work on education and enrollment in manufacturing copay card programs
• May provide patient education on copay assistance programs
• May administer order queues to include those waiting for payment
• May work on specialized PBM plans and/or be cross trained in specialized PBM plans
• Can and may perform the job responsibilities defined in Level 1
• Other responsibilities as judgment or necessity dictate

(Specialized Pharma/Disease Focused Team):

• Perform the job responsibilities listed above for programs that require special handling or provide support for specific disease states
• Other responsibilities as judgment or necessity dictate

N/A

• Constantly (67-100% of time OR 6 or more hours) required to sit, use hands to handle or feel, talk and hear
• Frequently (34-66% of time OR 4-6 hours) required to reach with hands and arms
• Occasionally (0-33% of time OR 1-3 hours) required to stand, walk and stoop, kneel and crouch
• Occasionally (0-33% of time OR 1-3 hours) required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
   

• High School diploma from an accredited school or equivalent GED
• 1 year of work experience 

• Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction
• Good verbal and written communication and interpersonal skills with the ability to communicate in a diplomatic and confidential manner
• Basic knowledge of and skills using MS Windows, MS Office Suite and/or other similar operating/software programs

• Experience in a healthcare, specialty pharmacy, PBM and/or call center setting