Specialist, Medical Insurance II
HybridHeredia, Heredia Province, Costa Rica
Job Summary
Provide subject matter expertise and best-in-class customer service for inbound and outbound calls to drive first-call resolution on complicated patient access challenges. Investigate and problem-solve for escalated issues involving disadvantaged access, savings card challenges, or non-preferred formulary by completing benefit investigations and communicating results to healthcare providers and patients. Maintain insurance intelligence by documenting details in the system of record, supporting training curriculum for new hires, and liaising between pharmacies, payors, and field representatives to administer patient support programs. Quickly execute business process changes and comply with federal, state, and local laws while meeting performance metrics.
Required Qualifications
- High school diploma or GED equivalent
- 2-4 years of work experience in a healthcare or reimbursement setting
- Previous experience in a call center environment, healthcare office, or specialty pharmacy
- Thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs
- Knowledge of billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations
- Experience and knowledge in Medicare Part D, Medicaid and alternate funding resources
- Knowledge of private payers, pharmacy benefits, and medical benefits
- Ability to lead and participate within a team
- Ability to manage multiple priorities and meet associated timelines while maintaining accuracy
- Proven leadership skills
- Professional written and verbal communication skills
- Ability to maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers
- Demonstrated strong, accurate technical skills
- Detail oriented
- Proven organizational and problem-solving skills
- Ability to elevate to management when appropriate
- Skilled with the use of the Microsoft Office suite
- Ability to use and effectively learn and navigate other computer systems
- Successful completion of role based training requirements, including passing certifications and competency assessments prior to conclusion of training period
- Understanding and compliance with all required training, including adherence to federal, state, and local laws, SPII policies and guidelines, and the policies and procedures of AbbVie Access Support and AbbVie
Desired Qualifications
- Degree
- Experience in a call center environment, healthcare office, or specialty pharmacy
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