Insurance Verification Specialist (Benefit Specialist)

About the role

A typical day in this role will include providing in-depth knowledge of our 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, in a compliant manner, that stand in the way of patients and their access to therapy.

Responsibilities

• Performing patient level benefits verifications as applicable for all major medical and pharmacy benefits plans.
• Completion of the template forms that provide patient level benefits Coverage Determination Summary.
• Cordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance.
• Patient Assistance:
  • Review of patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOPs and program guidelines.
  • Determination of patient’s eligibility based upon program criteria for qualification.
  • Communicating the patient’s eligibility to the patient, healthcare provider, and/or consignment pharmacy.
• Answer and assist inbound callers through resolution utilizing answers to frequently asked questions or by warm transferring callers to other appropriate individuals.
• Actively listen to each customer, assess needs, and respond with demonstrated patience and courtesy.
• Review and identification of information that is missing and/or incorrect within program service requests/program applications.
• Reporting of Adverse Events/Product Complaint inquiries received in accordance with SOP and good manufacturer practices.
• Provides timely feedback to the company regarding service failures or customer concerns.
• Effectively uses our internal technology platform, PharmaCord Lynk, to complete claims processing and keep workflows moving.
• Communicate with key medical practice accounts, sales representatives regarding the status of cases. Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy.

Qualifications

• The candidate must possess the following personal attributes: Service minded; focus on recognizing and meeting the needs of others (especially patients and care partners); Ability to handle personal health information with confidentiality; Commitment to honesty and integrity; Professionalism and a strong sense of proper business and customer service etiquette; Clear verbal and written communication skills; Accountability for results; Ability to plan and prioritize tasks and strong attention to detail; Proficient emotional intelligence (ability to recognize emotions and their effects); Ability to manage disruptive impulses and handle potentially stressful customer interactions; Proficient computer skills; Adaptability 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.

Physical Demands & Work Environment

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy. Although very minimal, flexibility to travel as needed is preferred. This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs.
• Additional health support, including telehealth and Employee Assistance Program (EAP) services.
• Company match on Health Savings Account contributions.
• Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000.
• Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability.
• 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting.
• Paid Time Off (PTO) and Sick Leave to support work-life balance.
• Opportunities for advancement in a company that supports personal and professional growth.
• A challenging, stimulating work environment that encourages new ideas.
• A mission-driven, inclusive culture where your work makes a meaningful impact.

  Why Work for Valeris?

  We’re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:

  Equal Opportunity Employer

  At Valeris, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.