Benefit Investigation Specialist

Overview Join our dynamic team as a Benefits Investigation Specialist and be a crucial part of ensuring access to essential medications We seek a compassionate individual to engage with Medical Insurance Payers and Pharmacy Benefit Managers, playing a vital role in identifying and documenting coverage options for retail and specialty medications. Why work with us? + Immerse yourself in an excellent company culture with fun events and volunteer opportunities. + Enjoy competitive benefits, including medical, dental, vision, and more. + Please take advantage of our 401k package with a dollar-for-dollar match-up. + Generous PTO and paid holiday days are offered. + Embrace opportunities for professional and personal growth in our team-oriented atmosphere. Responsibilities What you will do: + Connect with Payers and Pharmacy Benefit Managers via outbound calls to verify patient insurance coverage and uncover available Medical and Pharmacy benefits. + Communicate case details to relevant internal or external parties, fostering effective collaboration. + Identify potential mechanisms for quick access to therapy by recognizing any payer coverage restrictions. + Showcase your ability to contribute effectively, whether working independently or in small workgroups. + Meet production and time completion goals with a focus on maintaining high-quality customer service standards in accordance with federal and state regulations. + Accurately document payer Prior Authorization and Appeals protocols, ensuring meticulous attention to detail. + Participate in special projects and embrace additional duties as required, contributing to a dynamic work environment. + Maintain a comprehensive repository of payer or brand-specific coverage information. + Engage in training and process improvement initiatives to enhance your professional growth. Qualifications What we need from you: + A high school diploma or equivalent is required; a Bachelor's degree is preferred. + Minimum of 2 years of experience in customer service, insurance, benefits, marketing, sales, or a related area is required, or a Bachelor's degree with one year of relevant experience. + Preferred experience in a healthcare environment focusing on third-party benefits verification. + Understanding of commercial insurance concepts, including coverage policies, major medical benefits, and knowledge of government and patient assistance programs. + Highly proficient in computer skills, including Microsoft tools, working from dual monitors, etc. + Strong email correspondence and personal documentation skills. + Fundamental analytic and problem-solving skills with excellent time management. + Demonstrated professional customer service experience with high attention to detail. + Be a critical thinker who is adaptable and results-driven. Submit a Referral ( Share on News Feed LocationUS-PA-Pittsburgh ID2024-1787 Category Customer Service Position Type Full Time Remote No

Created: 2025-10-04