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, tackling complex patient access issues.

• Offer expertise and customer service for both inbound and outbound calls, ensuring first-call resolutions.

• Supply details on insurance coverage, verification, prior authorization status, and alternative funding options.

• Provide offices with the latest plan forms, portals, and websites for prior authorizations and appeals.

• Communicate and educate customers regarding the outcomes of investigations.

• Investigate and resolve escalated access problems, challenges with savings/copay cards, and issues with non-preferred formularies.

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

• Record information in the designated systems of record.

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

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

• Serve as a liaison among healthcare providers, insurers, AbbVie Patient Access Support representatives, Ambassadors, pharmacies, and patients.

• Educate stakeholders on access processes specific to insurance plans.

• Achieve or surpass departmental performance metrics.

• Assist with training programs and onboarding of new hires; mentor Insurance Specialist I team members.

• Collaborate across functions to pinpoint opportunities for process and productivity enhancements.

• 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.

• 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.

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

• Demonstrated leadership abilities.

• Strong professional written and verbal communication skills.

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

• Proficient technical skills with attention to detail.

• Excellent organizational and problem-solving capabilities.

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

• Successful completion of role-specific training, certifications, and competency evaluations.

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

🏝️ Benefits

• Paid time off, inclusive of vacation, holidays, and sick leave.

• Medical, dental, and vision insurance.

• 401(k) plan.

• Short-term incentive programs.

• Equal opportunity employer benefits and reasonable accommodation support.