Insurance Specialist II

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🕒 Ontem

🌽 Illinois – Remoto

🌽 Illinois – Remote

💵 $27 - $48 / hora

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

🔒 Seguros

🚫👨‍🎓 Sem graduação necessária

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AbbVie

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 2013

🏥 Saúde

💼 Consultoria

🏭 Manufatura

Healthcare • Consulting • Manufacturing

A AbbVie é uma empresa farmacêutica global que descobre e entrega medicamentos inovadores e soluções para melhorar vidas. Com foco em enfrentar os desafios de saúde mais difíceis do mundo, a AbbVie opera em mais de 175 países, oferecendo uma ampla gama de produtos em áreas como imunologia, oncologia, neurociência e estética. Comprometida com a inovação científica, a AbbVie investe fortemente em pesquisa e desenvolvimento, com o objetivo de produzir medicamentos inéditos. A empresa também dá ênfase à diversidade no ambiente de trabalho, sustentabilidade e iniciativas de apoio ao paciente, garantindo um impacto positivo tanto para seus pacientes quanto para a comunidade em geral.

Descrição

• Act as the primary point of contact for healthcare providers and patients addressing complicated patient access challenges • Provide insurance coverage, verification details, prior authorization status, and alternate funding options • Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions • Communicate and educate customers on investigation results • Investigate and resolve escalated access issues, savings/copay card challenges, and non-preferred formulary issues • Complete benefit investigations and contact healthcare providers, patients, pharmacies, or payers as necessary • Learn and execute business process and system changes for drugs and channel sources • Maintain business procedures, deviations, and case processing knowledge • Document information in the appropriate system of record and formats • Communicate insurance details to healthcare providers and patients by phone, electronic communication, and fax • Identify potential adverse events for Pharmacovigilance reporting to support FDA compliance • Support changing business priorities and tasks for patients, products, and services • Work cross-functionally to identify process and productivity improvements • Liaise among healthcare providers, insurance companies, AbbVie Patient Access Support field representatives, Ambassadors, pharmacies, and patients • Educate stakeholders on access processes specific to patients' insurance plans • Meet or exceed department performance metrics • Maintain privacy standards required by law and AbbVie policy • Support the Training department with curriculum and new-hire training • Coach and assist Insurance Specialist Level 1 employees • Complete role-based training, certifications, and competency assessments • Comply with applicable laws, SPII guidelines, and AbbVie policies and procedures • Perform additional tasks and projects assigned by management

🎯 Requisitos

• High school diploma or GED equivalent required • Degree preferred • 2–4 years of work experience in a healthcare or reimbursement setting • Previous experience in a call center environment, healthcare office, or specialty pharmacy preferred • Knowledge of commercial and government pharmacy and medical insurance programs preferred • Knowledge of billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations preferred • Experience with Medicare Part D, Medicaid, alternate funding resources, private payers, pharmacy benefits, and medical benefits preferred • Ability to lead and participate within a team, manage multiple priorities, meet timelines, and maintain accuracy • Proven leadership skills • Professional written and verbal communication skills • Ability to maintain a positive service image when handling challenging issues and unsatisfied customers • Strong and accurate technical skills • Detail-oriented • Organizational and problem-solving skills, with appropriate escalation to management • Proficiency with Microsoft Office suite and ability to learn and navigate other computer systems • Must successfully complete role-based training, certifications, and competency assessments • Must comply with federal, state, and local laws, SPII policies and guidelines, and AbbVie policies and procedures

🏖️ Benefícios

• Paid time off (vacation, holidays, sick) • Medical, dental, and vision insurance • 401(k) • Short-term incentive programs • Comprehensive benefits package • Equal opportunity employer • Reasonable accommodations for applicants