Insurance Specialist II

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔒 Insurance

🚫👨‍🎓 No degree required

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AbbVie

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2013

🏥 Healthcare

💼 Consulting

🏭 Manufacturing

Healthcare • Consulting • Manufacturing

AbbVie is a global pharmaceutical company that discovers and delivers innovative medicines and solutions to enhance lives. With a focus on addressing the world's toughest health challenges, AbbVie operates in over 175 countries, providing a wide range of products across areas like immunology, oncology, neuroscience, and aesthetics. Committed to scientific innovation, AbbVie invests heavily in research and development, aiming to produce first-in-class medicines. The company also emphasizes workplace diversity, sustainability, and patient support initiatives, ensuring positive impact for both its patients and the broader community.

📋 Description

• Serve as the primary point of contact for healthcare providers and patients with complicated patient access challenges • Provide insurance expertise and customer service for inbound and outbound calls to drive first-call resolution • Explain medical and pharmacy benefits, financial assistance, insurance coverage, prior authorizations, appeals, and alternate funding options • Provide offices with plan forms, portals, and websites for prior authorization and appeal submissions • Investigate and resolve escalated access issues, savings/copay card challenges, and non-preferred formulary issues • Complete benefit investigations and contact healthcare providers, patients, pharmacies, and payors as needed • Learn and execute business process and system changes for drugs and channel sources • Document information in the appropriate systems and formats • Communicate insurance details through phone, electronic communication, and fax • Identify potential adverse events for Pharmacovigilance reporting • Collaborate cross-functionally to identify process and productivity improvements • Liaise among healthcare providers, insurers, AbbVie field representatives, Ambassadors, pharmacies, and patients • Educate stakeholders on access processes specific to insurance plans • Meet or exceed departmental performance metrics • Support training curriculum and new hires • Coach and assist Insurance Specialist I employees • Complete required training, certifications, and competency assessments • Comply with privacy standards, laws, SPII guidelines, and AbbVie policies • Perform additional tasks and projects assigned by management

🎯 Requirements

• 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, billing, alternate funding, reimbursement, prior authorizations, appeals, and specialty pharmacy operations preferred • Knowledge of 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 ability to escalate to management when appropriate • Proficiency with Microsoft Office and ability to learn and navigate other computer systems • Successful completion of role-based training, certifications, and competency assessments • Compliance with federal, state, and local laws, SPII policies and guidelines, and AbbVie policies and procedures

🏖️ Benefits

• Paid time off (vacation, holidays, sick) • Medical, dental, and vision insurance • 401(k) • Short-term incentive programs • Training and role-based certifications • Equal opportunity employment • Reasonable accommodations for applicants