Benefit Specialist

About the role

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions to improve patient access to critical medications. This role involves providing in-depth knowledge of client programs by working directly with patients, healthcare providers, and insurance companies to answer inquiries, process service requests, assess benefits coverage, and manage through barriers.

Responsibilities

• Benefit Verification: Perform patient-level benefits verifications for all major medical and pharmacy benefits plans.
• Completion of template forms for patient-level benefits coverage determination.
• Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation, or guidance.
• Patient Assistance: Review patient assistance enrollment forms and supporting documentation to assess eligibility based on program criteria.
• Communicate patient eligibility to patients, healthcare providers, and consignment pharmacies.
• Answer and assist inbound callers through resolution, utilizing answers to frequently asked questions or by transferring callers to other appropriate individuals.
• Actively listen to each customer, assess needs, and respond with demonstrated patience and courtesy.
• Review and identify missing or incorrect information within program service requests/applications.
• Report adverse events/product complaints in accordance with SOP and good manufacturing practices.
• Provide timely feedback to the company regarding service failures or customer concerns.
• Effectively use internal technology platform, PharmaCord Lynk, to complete claims processing and keep workflows moving.
• Communicate with key medical practice accounts and sales representatives regarding the status of cases, providing consultative services to overcome obstacles.

Qualifications

• Service-minded; focus on recognizing and meeting the needs of others (especially patients and care partners).
• Commitment to honesty and integrity.
• Professionalism and strong sense of business and customer service etiquette.
• Clear verbal and written communication skills.
• Accountability for results.
• Strong attention to detail.
• Emotional intelligence (ability to recognize emotions and their effects).
• Able to manage disruptive impulses and handle potentially stressful customer interactions.
• Proficient computer skills.
• Adaptable to change.
• Personal initiative and commitment to team and organizational goals.
• A positive attitude!
• Bachelor's degree strongly preferred or equivalent experience required; completion of a high school diploma or GED is required.
• 6 months customer service experience, payer benefits experience (reimbursement, prior authorization, etc.), healthcare industry experience, or healthcare-related certification, license, or equivalent coursework is strongly preferred.
• Bilingual is a plus.

Benefits

Full-time employees can expect medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs. Additional health support includes telehealth and Employee Assistance Program (EAP) services. Company match on Health Savings Account contributions, free basic life and AD&D coverage, and company-paid Short-Term Disability coverage with the option to purchase Long-Term Disability. There is a 401(k) Retirement Savings Plan with a 100% match on the first 5% you contribute, with immediate vesting. Paid Time Off (PTO) and Sick Leave are provided to support work-life balance. Team members receive nine paid holidays plus two floating holidays, opportunities for advancement, and a challenging, stimulating work environment that encourages new ideas. Valeris is committed to supporting the well-being and success of its team members.