Insurance Specialist II

Job not on LinkedIn

🕒 2 days 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 insurance expertise and customer service for inbound and outbound calls to drive first-call resolution • Provide insurance coverage, verification, prior authorization, and alternate funding information • Supply offices with plan forms, portals, and websites for prior authorization and appeal submissions • Investigate and resolve escalated access issues, savings or copay card challenges, and non-preferred formulary issues • Complete benefit investigations and contact healthcare providers, patients, pharmacies, or payors as needed • Learn and execute business process and system changes for drugs and channel sources • Document information accurately in the appropriate systems • Communicate insurance details to healthcare providers and patients by phone, electronic communication, and fax • Identify potential adverse events for Pharmacovigilance reporting • Collaborate cross-functionally on process and productivity improvements • Liaise among healthcare providers, insurers, AbbVie field representatives, pharmacies, and patients to administer Patient Support Service programs • Educate stakeholders on access processes specific to patients' insurance plans • Meet or exceed department performance metrics • Maintain legally and company-required privacy standards • Support Training with curriculum and new-hire training • Coach and assist Insurance Specialist Level 1 employees • Complete role-based training, certifications, and competency assessments • Perform additional management-assigned tasks and projects

🎯 Requirements

• High school diploma or GED equivalent required • Degree preferred • 2–4 years of work experience in a healthcare or reimbursement setting • Previous call center, healthcare office, or specialty pharmacy experience preferred • Knowledge of commercial and government pharmacy and medical insurance programs • Knowledge of billing, alternate funding, reimbursement processes, prior authorization, 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 approach • Organizational and problem-solving skills, with ability to escalate to management when appropriate • 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