Benefit Investigation Specialist

Location: Pittsburgh, Pennsylvania (On-Site)

About the role

We are recruiting for a Benefit Investigation Specialist opportunity supporting high-volume insurance and pharmacy benefit verification work in a fast-paced environment. Our team is looking for a detail-oriented professional who can help ensure accurate coverage research, timely documentation, and strong customer service for internal and external stakeholders.

Responsibilities

• Make outbound calls to payers and pharmacy benefit managers to verify patient insurance coverage and identify available medical and pharmacy benefits.
• Document benefit verification results clearly and communicate case details to the appropriate internal or external parties.
• Identify payer coverage restrictions and document prior authorization and appeals protocols accurately.
• Support production goals, training initiatives, process improvements, and special projects as needed.

Requirements

• Minimum of 2 years of experience in customer service, insurance, benefits, marketing, sales, or a related area, or a bachelor’s degree with 1 year of relevant experience.
• High school diploma or equivalent required; bachelor’s degree preferred.
• Experience in a health care environment with third-party benefits verification preferred.
• Understanding of commercial insurance concepts, including coverage policies, major medical benefits, government and patient assistance programs, reimbursements, and third-party terms preferred.
• Ability to write routine reports and correspondence using computer applications, with strong verbal communication and medical terminology knowledge.
• Proficiency in Microsoft Office, including Excel, along with email management, note-taking during telephone conversations, time management, attention to detail, critical thinking, adaptability, and problem-solving skills.

About SSI People

With over 26 years of industry experience, SSi People has built its reputation and expertise on putting people first. Everything we do works toward delivering exceptional experience for our consultants, our clients, and our internal team. Through a genuine commitment to people in everything we do, we have developed refined processes and a stellar internal team to deliver talent quickly. More importantly, we focus on building long-term relationships, not transactions.