Specialist, Insurance II

Purpose

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 best-in-class customer service and alternate funding options . The position addresses issues and concerns to provide HCPs and patients with accurate explanations of patients medical and/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.

Responsibilities

• Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution. Provide insurance coverage verification details prior authorization statues and 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 non-preferred formulary issues. Where necessary complete a benefit 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 drugs and channel sources as applicable. Maintain an understanding of current business procedures deviations and case processing for all brands and channel sources for Insurance Specialist I role to support as needed.
• Documents information in the appropriate system of recordand formats. Accurately communicate insurance details to HCP 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. 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. Educate healthcare providers AbbVie Patient Access Support field representatives filling pharmacies and patients on access processes specific to their patients 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 new hires. 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 :

Qualifications

• 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. 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 problem-solving 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.

Additional Information :

Applicable only to applicants applying to a position in any location with pay disclosure requirements under state or local law: 

• The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this roleat  the time of this posting based on the job grade for this position. Individual compensation paid within this range will depend on manyfactors  including  geographic location and we may ultimately  pay more or less than the posted range. This range may be  modified in the future. 

• We offer a comprehensive package of benefits including paid time off (vacation holidays sick) medical/dental/vision insurance and 401(k) to eligible employees.

• This job is eligible to  participate in our short-term incentive programs.  Note: No amount of pay is  considered to be wages or compensation until such amount isearned  vested  and determinable. The amount and availability of  any bonus commission incentive benefits or any other form of compensation and benefits thatare allocable to a   particular employee  remains in the Companys sole and absolute discretion unless and until paid and may be  modified at the Companys sole andabsolute discretion  consistent with applicable law. 

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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Work :

Yes

Employment Type :

Full-time