Insurance Specialist II

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

📋 Description

• Act as the main point of contact for healthcare providers and patients dealing with intricate patient access issues.

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

• Offer offices the latest plan forms, portals, and websites necessary for prior authorizations and appeals.

• Educate customers regarding investigation outcomes.

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

• Conduct benefit investigations and reach out to healthcare providers, patients, pharmacies, or payors as required.

• Implement business process and system modifications for drugs and channel sources.

• Uphold business procedures, deviations, and case-processing expertise.

• Record information in the designated systems of record and formats.

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

• Identify potential adverse events for Pharmacovigilance reporting.

• Adapt to evolving business priorities and tasks for patients, products, and services.

• Collaborate across departments to enhance processes and productivity.

• Serve as a liaison between healthcare providers, insurance companies, AbbVie Patient Access Support representatives, Ambassadors, pharmacies, and patients.

• Educate stakeholders on insurance-specific access procedures.

• Achieve or surpass department performance metrics.

• Adhere to legally and policy-compliant privacy standards.

• Assist the Training department and support new hires.

• Mentor and aid Insurance Specialist Level 1 employees.

• Complete role-specific training, certifications, and competency evaluations.

• Undertake additional tasks and projects as assigned by management.

⛳️ Requirements

• High school diploma or GED equivalent is mandatory.

• Degree is preferred.

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

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

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

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

• Demonstrated leadership capabilities.

• Strong professional written and verbal communication abilities.

• Capacity to maintain a positive service image while addressing challenging issues and dissatisfied customers.

• Proficient and precise technical skills.

• Detail-oriented.

• Strong organizational and problem-solving skills, with the ability to escalate issues to management when necessary.

• Competent in using Microsoft Office suite and capable of learning and navigating other computer systems.

• Must complete mandatory training, certifications, and competency evaluations.

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

🏝️ Benefits

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

• Medical, dental, and vision insurance.

• 401(k).

• Eligibility to engage in short-term incentive programs.