Insurance Specialist II

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

📋 Description

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

• Deliver expert knowledge and exceptional customer service for both inbound and outbound calls to ensure first-call resolution.

• Offer details regarding insurance coverage, verification, prior authorization status, and alternative funding options for both existing and newly launched products.

• Provide offices with up-to-date plan forms, portals, and websites for prior authorizations and appeal submissions.

• Inform and educate customers about the results of investigations.

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

• Conduct benefit investigations and communicate with healthcare providers, patients, filling pharmacies, or payers as needed.

• Understand and implement changes in business processes and systems related to drugs and channel sources.

• Record information accurately in the designated system of record and formats.

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

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

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

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

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

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

• Achieve or surpass department performance metrics.

• Uphold legally and policy-compliant privacy standards.

• Assist the Training department and contribute to the new-hire training curriculum.

• Mentor and support Insurance Specialist Level 1 employees.

• Complete role-based 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 setting.

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

• 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.

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

• Capable of leading and engaging in teamwork, managing multiple priorities, meeting deadlines, and ensuring accuracy.

• Demonstrated leadership abilities.

• Strong written and verbal communication skills are required.

• Ability to maintain a positive service image when dealing with challenging situations and dissatisfied customers.

• Excellent technical skills with a focus on accuracy.

• Detail-oriented.

• Strong organizational and problem-solving abilities, escalating issues to management when appropriate.

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

• Successful completion of role-based training, certifications, and competency assessments.

• Adherence 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.

• Equal opportunity employer.

• Reasonable accommodations for applicants from the US and Puerto Rico.