Case Manager

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

📋 Description

• Deliver inbound and outbound phone assistance to payers, patients, caregivers, specialty pharmacies, care centers, distributors, compounders, and healthcare providers.

• Coordinate patient benefits, product orders, and appointments to enhance the patient experience.

• Act as a specialist in benefit coordination and available support resources.

• Manage interactions with healthcare providers and patients.

• Advocate for patients concerning eligibility, enrollment, affordability assistance, and therapy accessibility.

• Build and sustain relationships with healthcare providers and patients.

• Serve as the primary contact for ongoing program support and relationship enhancement.

• Clearly explain program and patient information to healthcare providers.

• Navigate payer challenges to achieve suitable resolutions.

• Collaborate with client contacts and internal stakeholders.

• Keep records in compliance with relevant standards and regulations.

• Adhere to program guidelines and escalate complex cases as per SOPs, Call Guides, and program materials.

• Provide customer service as a brand advocate and program representative.

• Relay patient status, prescriber feedback, coordination obstacles, and program effectiveness to Program Management.

• Evaluate patient situations and intervene to secure timely outcomes.

• Uphold confidentiality, privacy, ethical conduct, and professional standards.

• Foster team morale and assist in conflict resolution.

• Comply with corporate policies, procedures, and SOPs.

• Complete assigned tasks and projects.

⛳️ Requirements

• An Associate or Bachelor’s degree and 2 years of experience in reimbursement/insurance, healthcare billing, physician office, or health insurance processing preferred; or, in lieu of a degree, a High School diploma or equivalent with 5 years of relevant experience.

• Call Center/HUB or customer service experience with increasing levels of responsibility required.

• Exceptional oral and written communication abilities.

• Strong working knowledge of prior authorization and appeals processes required.

• Solid understanding of medical and pharmacy insurance terminology along with reimbursement/insurance, healthcare billing, physician office, health insurance processing or related benefit coordination experience.

• Excellent problem-solving and decision-making capabilities.

• High attention to detail and commitment to follow-through.

• Strong organizational skills in a dynamic environment.

• Ability to adapt to change while upholding program standards.

• Empathetic listening skills.

• Punctual, dependable, with a strong attendance record.

• Proficient in Microsoft Excel, Word, PowerPoint, and Outlook.

• Preference for candidates who can type at least 35 words per minute with 97% accuracy.

• Flexibility to travel as required is preferred.

• Successful completion of a background check and, depending on the role, a drug screen.

🏝️ Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing towards premium costs.

• Telehealth and Employee Assistance Program (EAP) services.

• Company matching on Health Savings Account contributions.

• Complimentary Basic Life and AD&D coverage equivalent to annual earnings, with a minimum of $50,000 and a maximum of $300,000.

• Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability.

• 401(k) Retirement Savings Plan with a 100% match on the first 5% contributed, with immediate vesting.

• Paid Time Off (PTO) and Sick Leave.

• Nine paid holidays plus two floating holidays.

• Opportunities for advancement and personal as well as professional growth.

• A challenging, stimulating work environment that promotes innovative ideas.

• An inclusive, mission-driven culture.

• Minimal travel flexibility preferred.