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 facing complex patient access issues.

• Offer insurance knowledge and customer service for both inbound and outbound calls to ensure first-call resolution.

• Clarify medical and pharmacy benefits, financial aid, insurance coverage, prior authorizations, appeals, and alternative funding options.

• Supply offices with required plan forms, portals, and websites for prior authorization and appeal submissions.

• Investigate and resolve escalated access problems, savings/copay card challenges, and issues related to non-preferred formularies.

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

• Acquire knowledge and implement business process and system changes for medications and channel sources.

• Accurately document information in the relevant systems and formats.

• Convey insurance details through phone, electronic communication, and fax.

• Recognize potential adverse events for Pharmacovigilance reporting.

• Collaborate across functions to pinpoint process and productivity enhancements.

• Act as a liaison among healthcare providers, insurers, AbbVie field representatives, Ambassadors, pharmacies, and patients.

• Educate stakeholders on access processes pertaining to specific insurance plans.

• Achieve or surpass departmental performance metrics.

• Support the training curriculum and assist new hires.

• Coach and support Insurance Specialist I team members.

• Complete all mandatory training, certifications, and competency assessments.

• Adhere to privacy standards, laws, SPII guidelines, and AbbVie policies.

• Undertake additional tasks and projects as directed by management.

⛳️ Requirements

• High school diploma or GED equivalent is mandatory.

• A degree is preferred.

• 2–4 years of experience in a healthcare or reimbursement setting 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, billing, alternative funding, reimbursement, prior authorizations, appeals, and specialty pharmacy operations is preferred.

• Understanding of 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, meet deadlines, and maintain accuracy.

• Demonstrated leadership abilities.

• Strong professional written and verbal communication skills.

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

• Strong technical skills with accuracy.

• Attention to detail.

• Organizational and problem-solving skills, with the capacity to escalate issues to management when necessary.

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

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

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

🏝️ Benefits

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

• Medical, dental, and vision insurance coverage.

• 401(k) plan.

• Short-term incentive programs.

• Training and role-specific certifications.

• Equal opportunity employment commitment.

• Reasonable accommodations for applicants.