Insurance Resolution Specialist - Mid Shift

PANTHERx is the nation’s largest rare disease pharmacy, prioritizing the patient experience in all aspects of our work. We seek team members who are inspired, compassionate problem solvers committed to achieving superior health outcomes for people living with rare and devastating diseases. Our employees drive our mission, and we cultivate talent to encourage growth and career exploration.

About the role

The Insurance Resolution Specialist (Mid Shift) verifies patient pharmacy and medical claims accurately and quickly, acting as a liaison between patients, insurance companies, and government agencies to ensure timely medication delivery and proper billing.

This full-time, non-exempt position is based in Pittsburgh, PA (Hybrid) and reports to the Supervisor, Patient Access. The schedule is Monday through Friday, with shifts of either 9:30AM–6:30PM or 10AM–6:30PM.

Responsibilities

• Verifies all benefit information needed to process a claim under pharmacy or medical coverage.
• Processes pharmacy claims on the patient’s behalf through a pharmacy benefit system.
• Verifies medical benefits accurately on the patient’s behalf.
• Obtains authorizations and overrides as needed in coordination with insurance providers.
• Processes patient information for copay cards and/or assistance programs.
• Reviews patient financial responsibility, obtains patient consent, and secures payment.
• Ensures proper shipment set-up of prescriptions.
• Supports special projects and other tasks as assigned.

Requirements

• High school diploma or general education degree (GED).
• Minimum 2 years’ experience processing pharmacy claims and benefit investigation.
• Strong written and verbal communication skills.
• Ability to multitask.
• Proficient with Cover My Meds (CMM), EDS billing systems, Excel, and Word.

Preferred Qualifications

• Experience or knowledge within the healthcare industry, particularly a mail order or specialty pharmacy.
• Strong understanding of benefit verification/prior authorization process.
• Experience with CPR+.

Work Environment

This position operates in a home or professional office environment and routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.

Physical Demands

While performing the duties of this job, the employee is regularly required to sit, see, talk, or hear. The employee frequently stands, walks, uses hands and fingers, handles or feels, and reaches with hands and arms. Visual acuity is necessary for extended periods of computer work. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

Benefits

• Hybrid, remote, and flexible on-site work schedules (based on position).
• Medical, dental, and vision coverage.
• Health savings and flexible spending accounts.
• 401K with employer matching.
• Employer-paid life insurance and short/long-term disability coverage.
• Employee Assistance Program.
• Generous paid time off for full-time employees; limited paid time off for part-time employees.
• Paid holidays.