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

• Act as the primary point of contact for healthcare providers and patients addressing complicated patient access challenges • Provide subject matter expertise and best-in-class customer service for inbound and outbound customer calls to drive first-call resolution • Provide insurance coverage and verification details, prior authorization status, and alternate funding options for existing and newly launched products • 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, including complex access, savings/copay card challenges, and non-preferred formulary issues • Complete benefit investigations and contact healthcare providers, patients, filling pharmacies, or payers as necessary • Learn and execute business process and system changes for drugs and channel sources • 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 regulatory 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, filling pharmacies, and patients • Educate stakeholders on access processes specific to patients' insurance plans • Meet or exceed department performance metrics • Maintain legally and policy-compliant privacy standards • Support the Training department and new-hire training curriculum • Coach and assist Insurance Specialist Level 1 employees • Complete role-based training, certifications, and competency assessments • 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 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 required • 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 • 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 insurance • Dental insurance • Vision insurance • 401(k) • Eligibility to participate in short-term incentive programs • Equal opportunity employer • Reasonable accommodation for US and Puerto Rico applicants