Insurance Specialist II

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

📋 Description

• Serve as the primary liaison for healthcare providers and patients encountering intricate patient access challenges.

• Deliver insurance knowledge and customer support for both incoming and outgoing calls to achieve first-call resolution.

• Clarify insurance coverage, benefits, financial assistance, prior authorizations, appeals, and alternative funding options.

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

• Investigate and resolve complex access issues, savings/copay card difficulties, and non-preferred formulary challenges.

• Conduct benefit investigations and communicate with healthcare providers, patients, pharmacies, and payors as necessary.

• Maintain insurance knowledge and document relevant information in the appropriate systems.

• Relay insurance information through phone calls, electronic communications, and fax.

• Identify potential adverse events for Pharmacovigilance reporting in compliance with FDA regulations.

• Act as a liaison among healthcare providers, insurance companies, AbbVie field representatives, pharmacies, and patients to manage Patient Support Service programs.

• Educate stakeholders on insurance-specific access procedures.

• Achieve or surpass departmental performance metrics.

• Assist in training curriculum and onboarding new hires; mentor Insurance Specialist Level 1 employees.

• Collaborate cross-functionally to identify process and productivity enhancements.

• Complete mandatory training, certifications, and competency evaluations.

• Undertake additional tasks and projects as 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.

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

• Familiarity with commercial and government pharmacy and medical insurance programs, billing, alternative funding resources, reimbursement processes, prior authorizations, and appeal filings, as well as specialty pharmacy operations is preferred.

• Experience with Medicare Part D, Medicaid, alternative funding resources, private payers, pharmacy benefits, and medical benefits is preferred.

• Capability to lead and engage within a team, manage multiple priorities, adhere to timelines, and maintain accuracy.

• Demonstrated leadership abilities.

• Professional written and verbal communication skills.

• Capacity to uphold a positive service image when addressing challenging issues and dissatisfied customers.

• Strong and precise technical skills.

• Detail-oriented.

• Excellent organizational and problem-solving skills, with appropriate escalation to management.

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

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

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

🏝️ Benefits

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

• Medical insurance.

• Dental insurance.

• Vision insurance.

• 401(k) plan.

• Eligibility to participate in short-term incentive programs.