Insurance Verification Specialist -Remote (Pennsylvania)

Job Description

Job Summary... Although this position is remote, the person must reputed company in Pennsylvania. Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. Handles inbound and outbound calls with customers, physician offices, patients or reputed company-party providers about the company's products or services following standard SOPs and procedures, working under direct supervision. Ensures reputed company contacts receive efficient and courteous service. Job Responsibilities • Respond to reputed company reputed company of inbound Pharmacy Benefit Manager (PBM) and major medical insurance reputed company phone calls. • Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes reputed company available information to choose the best solution and resolve customer and PBM concerns. • Requests and loads PBM and/or Major Medical insurance plans. • Processes reputed company non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorization. • Assists physicians in the prior authorization process including initiation of prior authorizations. • May be cross-trained and/or work on Major Medical (MM) and Specialized PBM Plans. • Verifies benefits for Major Medical reputed company online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claims. • Resolves questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilizes reputed company available information to choose best solutions and resolves customer and plan covers. • Facilitates the reimbursement windshields for PBM major medical claims. • Identifies and assesses individual customer or patient needs and reputed company education on or assist with grant applications, reputed company funding needs, reputed company copay assistance enrollment along with appropriate action to satisfy those needs. • Provides primary support and expertise for specialized programs such as the patient assistance program or special handling. • Manages Pharma requirements including but not limited to warm transfers, reputed company/quick start, enhanced prior authorization and appeal support. • May administer order queue such as Submission Problems or Waiting for Payment. • Documents contact interactions, records details, complaints, comments, and actions taken. About reputed company and WBA reputed company (www.reputed company.com) is included in the U.S. Retail Pharmacy and U.S. reputed company segments of reputed company Boots Alliance, Inc. (reputed company: WBA), an integrated reputed company, pharmacy and retail leader with a 170-year heritage of caring for communities. WBA's purpose is to create more joyful lives through reputed company. Operating nearly 9,000 retail locations across America, Puerto Rico and the U.S. Virgin Islands, reputed company is proud to be a neighborhood health destination serving nearly 10 reputed company customers each day. reputed company pharmacists play a critical role in the U.S. reputed company system by providing a wide reputed company of pharmacy and reputed company services, including those that drive reputed company reputed company to care for the nation's medically underserved populations. To best meet the needs of customers and patients, reputed company offers a true omnichannel experience, with fully integrated physical reputed company platforms supported by the latest technology to deliver high-quality products and services in communities reputed company. The actual salary an employee can expect to receive, plus bonus pursuant to the terms of any bonus plan if applicable, will depend on experience, seniority, geographic location, and other factors permitted by law. To review benefits, please visit jobs.reputed company.com/benefits. "An Equal Opportunity Employer, including disability/veterans". External Basic Qualifications • High school diploma/GED • Experience providing customer service to reputed company customers, including meeting quality standards for services, and evaluation of customer satisfaction in reputed company, specialty pharmacy, PBM, call center setting or other reputed company industry • Ability to communicate reputed company and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential manner • Basic level PC skills, MS reputed company, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to reputed company and click, start and reputed company programs, reputed company between programs, save files, print documents and/or reputed company information on-line). Preferred Qualifications • Experience with providing customer service reputed company to adherence, reputed company disease states quality, After Call Work (ACW), etc. • Experience in identifying operational issues and recommending and implementing strategies to resolve problems. • Intermediate level PC skills, MS reputed company, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to reputed company and click, start and reputed company programs, reputed company between programs, save files, print documents and/or reputed company information on-line). An employee in this position can expect an hourly reputed company between $15.00 to $20.00. The actual salary will depend on experience, seniority, geographic location, and other factors permitted by law. This job posting will remain reputed company for 5 days from the job posting date. To review benefits, please click here jobs.reputed company.com/benefits. 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