Insurance Specialist II

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

📋 Description

• Act as the main contact for healthcare providers and patients, addressing complex patient access issues.

• Offer expert knowledge and customer support for incoming and outgoing calls to achieve first-call resolution.

• Supply insurance coverage information, verification details, prior authorization updates, and alternative funding options.

• Provide offices with updated plan forms, portals, and websites for prior authorizations and appeal submissions.

• Communicate and educate customers regarding investigation outcomes.

• Investigate and resolve escalated access issues, challenges related to savings/copay cards, and non-preferred formulary problems.

• Conduct benefit investigations and reach out to healthcare providers, patients, filling pharmacies, or payers as needed.

• Learn and implement business process and system changes for medications and channel sources.

• Maintain and supply insurance intelligence to support the wider access team.

• Document information in the designated systems and formats.

• Communicate insurance information to healthcare providers and patients through phone, electronic communication, and fax.

• Identify possible adverse events for Pharmacovigilance reporting in accordance with FDA regulations.

• Adapt to changing business priorities and tasks related to patients, products, and services.

• Collaborate across functions to identify process and productivity enhancements.

• Act as a liaison among healthcare providers, insurance companies, AbbVie Patient Access Support representatives, Ambassadors, filling pharmacies, and patients.

• Educate stakeholders on access processes specific to patients' insurance plans.

• Achieve or surpass department performance metrics.

• Uphold privacy standards mandated by law and AbbVie policy.

• Assist the Training department, including training curriculum and onboarding new hires.

• Coach and support Insurance Specialist Level 1 employees.

• Complete necessary role-based training, certifications, and competency assessments.

• Undertake additional tasks and projects assigned by management.

⛳️ Requirements

• High school diploma or GED equivalent is required.

• A degree is preferred.

• 2–4 years of experience in a healthcare or reimbursement environment.

• Previous experience in a call center, healthcare office, or specialty pharmacy is preferred.

• Familiarity with commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and appeal submissions, and specialty pharmacy operations is preferred.

• Knowledge and experience with Medicare Part D, Medicaid, alternate funding resources, private payers, pharmacy benefits, and medical benefits is preferred.

• Capability to lead and engage with a team, manage multiple priorities, meet deadlines, and ensure accuracy.

• Demonstrated leadership abilities.

• Professional written and verbal communication skills.

• Ability to maintain a positive service image when addressing challenging issues and dissatisfied customers.

• Strong, precise technical skills.

• Detail-oriented approach.

• Strong organizational and problem-solving abilities.

• Proficiency in the Microsoft Office suite and the ability to learn and navigate other computer systems.

• Must successfully complete role-based training, certifications, and competency assessments.

• Must adhere to all federal, state, and local laws, SPII policies and guidelines, and AbbVie policies and procedures.

🏝️ Benefits

• Paid time off (including vacation, holidays, and sick leave).

• Medical, dental, and vision insurance coverage.

• 401(k) retirement plan.

• Eligibility to participate in short-term incentive programs.