Insurance Specialist II

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

📋 Description

• Serve as the main point of contact for healthcare providers and patients encountering complex patient access issues.

• Offer insurance knowledge and customer support through both inbound and outbound calls.

• Clarify insurance benefits, financial aid, prior authorizations, appeals, and alternative funding solutions.

• Supply offices with up-to-date forms, portals, and websites needed for prior authorizations and appeals.

• Investigate and address escalated issues related to access, savings cards/copay cards, and formularies.

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

• Keep updated on insurance information and record details in the relevant systems.

• Convey insurance information via phone, electronic communications, and fax.

• Identify potential adverse events for reporting in Pharmacovigilance.

• Coordinate communication between healthcare providers, insurers, AbbVie field representatives, pharmacies, and patients.

• Educate stakeholders about insurance-related access procedures.

• Achieve or surpass departmental performance benchmarks.

• Assist in developing training materials and onboarding new employees.

• Mentor and support Insurance Specialist Level 1 staff.

• Collaborate across functions to enhance processes and productivity.

• Complete training, certifications, and competency evaluations relevant to the role.

• Adhere to privacy regulations, legal standards, and AbbVie policies.

• Undertake additional tasks and projects as assigned by management.

⛳️ Requirements

• High school diploma or GED equivalent is mandatory.

• A degree is preferred.

• 2 to 4 years of experience in a healthcare or reimbursement environment is required.

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

• Familiarity with commercial and government pharmacy and medical insurance programs is a plus.

• Understanding of billing, alternative funding sources, reimbursement processes, prior authorization, appeal submissions, and specialty pharmacy operations is preferred.

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

• Capability to lead and engage in a team environment.

• Ability to juggle multiple priorities and deadlines while ensuring accuracy.

• Demonstrated leadership abilities.

• Excellent written and verbal communication skills.

• Capacity to maintain a positive service image when addressing difficult situations and dissatisfied customers.

• Strong and precise technical skills.

• Detail-oriented with robust organizational and problem-solving abilities.

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

• Must successfully complete role-specific training, certifications, and competency evaluations.

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

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• 401(k) retirement plan.

• Short-term incentive programs.

• Option for remote work.