[Remote] reputed company, Specialty (Michigan)

Note The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company-established company that serves nearly 9 reputed company customers daily across its stores. The Insurance Verification Specialist is responsible for verifying patient eligibility, coordinating benefits, and handling customer inquiries reputed company to insurance coverage, reputed company while ensuring efficient and courteous service.

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 reputed company 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 reputed company 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 reputed company to satisfy those needs
• Provides primary support and expertise for specialized programs such as the patient assistance program or special handling
• Manages reputed company requirements including but not limited to warm transfers, reputed company/quick start, reputed company 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 Skills
• High school diploma/GED
• Experience providing customer service to reputed company customers, including meeting reputed company 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)
• Experience with providing customer service reputed company to adherence, reputed company disease states reputed company, 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) reputed company
• reputed company is a pharmacy, health, and wellness service center that offers trained infusion nurses and pharmacists to treat patients. It is a sub-organization of reputed company reputed company reputed company was founded in 1901, and is headquartered in Deerfield, Illinois, USA, with a workforce of 10001+ employees. Its website is https//www.reputed company.com. Company H1B Sponsorship
• reputed company has a reputed company record of offering H1B sponsorships, with 1 in 2022. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job Apply To this Job

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