Insurance Verification Specialist -Remote (Michigan)

Walgreens

Aug 1

Applications are closed

Job
Full-time
Entry Level
Canton

Requirements

High school diploma/GED
Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in healthcare, specialty pharmacy, PBM, call center setting or other related industry
Ability to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential manner
Basic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).
Experience with providing customer service related to adherence, complex disease states quality, After Call Work (ACW), etc.
Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
Intermediate level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).

Responsibilities

Respond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls.
Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes all available information to choose the best solution and resolve customer and PBM concerns.
Requests and loads PBM and/or Major Medical insurance plans.
Processes all non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorization.
Assists physicians in the prior authorization process including initiation of prior authorizations.
May be cross-trained and/or work on Major Medical (MM) and Specialized PBM Plans.
Verifies benefits for Major Medical via online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claims.
Resolves questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilizes all available information to choose best solutions and resolves customer and plan covers.
Facilitates the reimbursement windshields for PBM major medical claims.
Identifies and assesses individual customer or patient needs and provides education on or assists with grant applications, complex funding needs, commercial copay assistance enrollment along with appropriate action to satisfy those needs.
Provides primary support and expertise for specialized programs such as the patient assistance program or special handling.
Manages Pharma requirements including but not limited to warm transfers, bridge/quick start, enhanced prior authorization and appeal support.
May administer order queue such as Submission Problems or Waiting for Payment.
Documents contact interactions, records details, complaints, comments, and actions taken.

FAQs

Is this position remote?

Yes, this position is fully remote, but the candidate must reside in the state of Michigan.

What are the main responsibilities of the Insurance Verification Specialist?

The main responsibilities include verifying patient eligibility, coordinating benefits, running test claims, assisting with prior authorizations, handling inbound and outbound calls, and resolving questions related to pharmacy benefit managers and major medical insurance.

What qualifications are required for this role?

A high school diploma or GED is required, along with experience in providing customer service in healthcare or related industries. Additionally, candidates should possess basic computer skills and the ability to communicate effectively.

What are the preferred qualifications for this position?

Preferred qualifications include experience related to adherence in complex disease states, the ability to identify operational issues, and intermediate PC skills, particularly with MS Office Suite.

What is the hourly pay range for this position?

The hourly rate for this position ranges from $16.50 to $22.00, depending on experience, seniority, geographic location, and other factors.

What type of training or onboarding is provided for this position?

The job description does not specify training details, but it mentions that the role works under direct supervision, suggesting that training will be provided as needed.

What benefits are offered with this position?

The specific benefits are not detailed in the job posting, but candidates are encouraged to visit jobs.walgreens.com/benefits for a comprehensive overview.

What kind of support can the Insurance Verification Specialist provide to customers and physicians?

They can assist with the prior authorization process, resolve inquiries related to PBM and major medical insurance, provide education on funding needs, and support specialized programs such as patient assistance.

Is experience in a call center setting required for this role?

While experience in a call center setting is not explicitly required, any experience providing customer service in healthcare or a related industry is beneficial.

Is there any specific software knowledge required for this position?

Basic PC skills and familiarity with MS Windows and the MS Office Suite are required. Intermediate skills are preferred.

Walgreens

Retail & Consumer Goods

Industry

10,001+

Employees

Mission & Purpose

Walgreens is a leading pharmacy and retail company in the United States, providing a wide range of health and wellness products, prescription medications, and services. Their ultimate aim is to champion the health and well-being of communities by offering convenient and accessible healthcare solutions. Walgreens focuses on improving health outcomes and ensuring that customers have access to essential health services and products.