Specialist Insurance II- Permanent role
Specialist Insurance II- Permanent role
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Salary Not Disclosed
1 Vacancy
Job Description
The Insurance Specialist II acts as the primary point of contact for Health Care Providers (HCPs) and patients when addressing complicated patient access challenges. This position will be a subject matter expert in insurance prior authorizations bestinclass customer service and alternate funding options . The position addresses issues and concerns to provide HCPs and patients with accurate explanations of patients medicaland/or pharmacy benefits financial assistance and access questions. Additionally this position enables the productivity of the broader access team by building maintaining and providing access to the insurance intelligence.
- Provide subject matter expertise and bestinclass customer service for all inbound and outbound customercalls to drive first call resolution.
- Provide insurance coverage verification details prior authorization statuesand alternate funding options for existing and newly launched products.
- Provide offices with current plan forms portals and websites for prior authorizations and appeal submissions.
- Clearly communicate and educate customers on results of the investigation Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access savings card/copay card challenges or nonpreferred formulary issues.
- Where necessary complete abenefit investigation contact the HCP and/or patient or potentially the filling pharmacy or payor.
- Quickly learn and execute business process and system changes for all and channel sources as applicable.
- Maintain an understanding of current business procedures deviations and case processing for allbrands and channel sources for Insurance Specialist I role to support as needed.
- Documents information in the appropriate system of recordand formats. Accurately communicate insurancedetails to HCP and patients via phone other electronic communication methods and fax as per establishedpolicies and procedures.
- Identify potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDAregulations. 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 crossfunctionally to identify and share opportunities for process and productivity improvements. Liaise between healthcare providers insurance companies AbbVie Patient Access Support field rep.s Ambassadors filling pharmacies and patients to administer the Patient Support Service programs. Educatehealthcare providers AbbVie Patient Access Support field representatives filling pharmacies and patientson access processes specific to their patient's insurance plan.
- Meet or exceed department standards relative to performance metrics.
- Maintain a work environment that upholds privacy standards required by law and AbbVie policy.
- Act as a resource for the Training department including providing support for training curriculum and newhires.
- Provide side by side coaching and assistance for Insurance Specialist Level 1s. Successfully complete role based training requirements including passing certifications and competency assessments prior to conclusion of training period.
- Understand and comply with all required training including adherence to federal state and local laws SPII policies and guidelines and the policies and procedures of AbbVie Access Support and AbbVie. Perform additional tasks activities and projects as deemed necessary by management.
Qualifications :
- High school diploma or GED equivalent required.
- Experience and knowledge in Medicare Part D Medicaid and alternate funding resources private payerspharmacy benefits and medical benefits preferred.
- Demonstrated ability to lead and participate within a team manage multiple priorities and meet associated timelines while maintaining accuracy.
- Proven leadership skills.
- Professional written and verbal communication skills are 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.
- Must be detail oriented.
- Proven organizational and problemsolving skills elevating to management when appropriate.
- Skilled with the use of the Microsoft Office suite and the ability to use and effectively learn and navigate other computer systems.
Preferred
- 24 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 programsbilling alternate funding resources reimbursement processes prior authorization and appeal filings and specialty pharmacy operations
Additional Information :
En AbbVie estamos comprometidos a cultivar una cultura laboral que promueva la inclusin la diversidad y el crecimiento personal. Reconocemos que nuestro xito colectivo se basa en el bienestar individual de nuestros colaboradores y es por eso que hemos diseado un paquete de beneficios pensando en cada aspecto de su vida.
- Cobertura Mejorada de Salud y Bienestar: Nuestro personal administrativo goza de un seguro mdico y dental integral asegurando tranquilidad para usted y sus seres queridos.
- Vacaciones Extendidas: Creemos en el equilibrio entre el trabajo y la vida personal de nuestro equipo administrativo. Por eso ofrecemos das adicionales de vacaciones ms all de los requisitos legales.
- Modelo de Trabajo Hbrido Flexible: Para los puestos elegibles dentro de nuestro personal administrativo adoptamos un esquema de trabajo hbrido que le permite la comodidad de teletrabajar durante dos das a la semana.
- Seguro de Vida: Asegure el futuro de su familia con nuestra pliza de seguro de vida.
- Avance Educativo: Invierta en su futuro con nuestro programa de becas disponible para empleados y sus dependientes.
- Programa de Asistencia al Empleado (EAP): Acceda a apoyo profesional con nuestro EAP integral que ofrece asesoramiento psicolgico legal y financiero.
- Servicios de Salud en la Empresa: Benefciese de la comodidad de contar con un mdico de la empresa y servicios de fisioterapia demostrando nuestro compromiso con su salud y bienestar.
- Compromiso Comunitario y Social: Haga la diferencia con un da de voluntariado pagado que le permite contribuir a la comunidad durante el horario laboral de la empresa.
- Beneficios Especiales de Permiso: Celebre sus logros de vida con das adicionales de permiso por matrimonio y disfrute de su cumpleaos con un da libre.
- Plan de Compra de Acciones para Empleados: Participe en el xito de nuestra compaa comprando acciones a un precio especial exclusivo para empleados.
- Transporte y Comidas Subsidiadas: Disfrute de la facilidad de transporte y de las comidas con nuestros servicios de transporte y cafetera subsidiados.
- Asociacin Solidarista: nase a una comunidad enfocada en la ayuda mutua y disfrute de los beneficios que conlleva ser miembro.
AbbVie is an equal opportunity employer and is committed to operating with integrity driving innovation transforming lives and serving our community. Equal Opportunity Employer/Veterans/Disabled.
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Employment Type :
Fulltime
Employment Type
Full-time
