Benefit Investigation Specialist

Responsibilities

• 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.
• Maintain 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

• 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.

Compensation & Benefits

• Compensation for this role varies based on factors such as location, relevant skills, experience, and capabilities.
• Employees at ConnectiveRx can enroll in comprehensive benefit plans, including medical, dental, vision, life, and disability insurance.
• The company retains the right to update or modify health, welfare, and other fringe benefit policies.
• Employees may also participate in the company's 401(k) plan.
• Time-Off & Holidays: ConnectiveRx provides paid time off (PTO) to non-exempt employees for vacations and personal leave. For sick leave, eligible non-exempt employees receive Sick Time Off (STO) in accordance with company policy. PTO and STO are prorated during the first year of service. Employees also receive eight standard company holidays and three floating holidays annually, with floating holidays prorated in the first year.
• The company is committed to maintaining competitive benefits and reserves the right to adjust employee offerings, including PTO, STO, and holiday policies, in compliance with applicable laws and regulations.
• Posted Salary Range: USD $15.26 - USD $22.00 /Hr.