Insurance Specialist II

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔒 Insurance

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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 addressing complicated patient access challenges • Provide subject matter expertise and customer service for inbound and outbound calls to drive first-call resolution • Provide insurance coverage and 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, filling pharmacies, or payors as needed • Learn and execute business process and system changes for drugs and channel sources • Maintain understanding of business procedures, deviations, and case processing • Document information in the appropriate system of record and formats • Communicate insurance details via phone, electronic communication, and fax • Identify potential adverse event situations for Pharmacovigilance reporting and FDA compliance • Support changing business priorities and tasks for patients, products, and services • Identify and share process and productivity improvement opportunities cross-functionally • Liaise among healthcare providers, insurance companies, AbbVie 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 with curriculum and new-hire training • Coach and assist Insurance Specialist Level 1 employees • Perform additional tasks and projects as directed by management

🎯 Requirements

• High school diploma or GED equivalent required • 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 • Understanding 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 and knowledge in Medicare Part D, Medicaid, alternate funding resources, private payers, pharmacy benefits, and medical benefits preferred • Demonstrated ability to lead and participate within a team, manage multiple priorities, and meet timelines while maintaining accuracy • Proven leadership skills • Professional written and verbal communication skills • Ability to maintain a positive service image when dealing with challenging issues and unsatisfied customers • Strong, accurate technical skills • Detail-oriented • Organizational and problem-solving skills, with appropriate escalation to management • Skilled with Microsoft Office suite and able to learn and navigate other computer systems • Successful completion of role-based training requirements, certifications, and competency assessments • Compliance with federal, state, and local laws, SPII policies and guidelines, and AbbVie policies and procedures

🏖️ Benefits

• Paid time off including vacation, holidays, and sick leave • Medical, dental, and vision insurance • 401(k) • Eligibility to participate in short-term incentive programs