Benefits Verification Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct benefit investigations and verify insurance benefits for patients and physicians’ offices.

• Submit and obtain prior authorizations as mandated by payers.

• Acquire recertification for cases that require extended treatment or coverage.

• Precisely enter and maintain data in client databases and patient files.

• Monitor outstanding items and ensure completeness of case files.

• Engage in conference calls regarding case status, drug orders, and alternative funding.

• Coordinate product orders, shipments, and therapy initiation with pharmacies and patients.

• Participate in call center operations and manage incoming calls from patients, insurers, physicians, sales representatives, pharmacies, and homecare agencies.

• Act as a point of contact for assigned prescribers.

• Identify and report events required by REMS regulations.

• Recognize adverse events, product quality complaints, and potential risk events, forwarding them for manufacturer reporting.

• Educate patients, prescribers, and others regarding program requirements and facilitate referrals.

• Uphold housekeeping, quality, production, safety, and environmental standards.

⛳️ Requirements

• High School Diploma/GED or equivalent experience.

• 4–6 years of experience in the insurance, biotechnology, or pharmaceutical sectors; customer service and/or reimbursement.

• Experience in health insurance claims or patient accounting is a plus.

• Proficiency in MS Office applications; experience with databases is advantageous.

• Exceptional written and verbal communication skills, with a proven ability to interact with individuals at all levels.

• Capability to manage multiple priorities and adhere to deadlines.

• Detail-oriented with strong analytical skills.

• Preferred knowledge of third-party billing, coding, medical terminology, prior authorizations, and appeals.

• Must adhere to applicable company, state, and federal safety and environmental policies and procedures.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.*

• Tuition reimbursement programs.

• Flexible working environment.

• 20 days of paid time off (PTO).

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision insurance coverage.

• Health Savings Account (HSA)/Flexible Spending Account (FSA).

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance programs.

• Short-term and long-term disability coverage.

• Life insurance options.

• Employee discount programs.