Benefits Verification Specialist

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

📋 Description

• Perform benefit investigations and verify insurance coverage for patients and medical offices.

• Submit requests and obtain prior authorizations and recertifications from payers for prolonged treatment or coverage.

• Enter and maintain accurate data in client databases and patient records.

• Track outstanding items and ensure case files are complete.

• Engage in conference calls with Client Sales Representatives, client management, and medical offices to discuss case status, drug orders, and alternative funding options.

• Organize product orders, shipments, and therapy initiation in collaboration with pharmacies and patients.

• Participate in call center operations and triage incoming calls from patients, insurance providers, medical professionals, sales representatives, pharmacies, and home care agencies.

• Act as a primary contact for a designated group of prescribers when applicable.

• Identify and report events as mandated by REMS requirements.

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

• Provide education to patients, prescribers, and others regarding program requirements and facilitate referrals.

• Uphold housekeeping, quality, and production standards while complying with relevant safety and environmental policies and procedures.

⛳️ 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 is preferred.

• Experience with health insurance claims or patient accounting is an advantage.

• Proficiency in MS Office applications; database experience is a plus.

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

• Ability to juggle multiple priorities and meet deadlines.

• Detail-oriented with strong analytical skills.

• Familiarity with third-party billing, coding, medical terminology, prior authorizations, and appeals is preferred.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for professional growth and advancement.

• 401K plan with company matching*

• Tuition reimbursement programs.

• Flexible work environment.

• 20 days of paid time off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Telemedicine options (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability insurance.

• Long-term disability insurance.

• Life insurance coverage.

• Discount programs.