Insurance Verification Specialist - Specialty Pharmacy

Role Overview

The Insurance Verification Specialist helps patients gain access to necessary medications and treatments by collaborating closely with healthcare providers and insurance payers. This position plays a key part in ensuring insurance benefits and coverage details are accurately verified, prior authorizations are handled, and reimbursement issues are navigated effectively.

Key Responsibilities

• Ensure patient cases progress correctly and adhere to company protocols, delivering high-quality service and compliance.
• Conduct benefit investigations via outbound calls to payers to confirm patient insurance coverage and navigate reimbursement complexities.
• Verify and document critical patient insurance benefit details such as coverage limits, cost shares, and provider options.
• Identify coverage restrictions and explore strategies to accelerate patient access to therapies.
• Manage documentation and initiation of prior authorizations and claims appeals as needed.
• Track and report trends in reimbursement or delays impacting patient access to management.
• Serve as a liaison connecting field representatives, healthcare providers, and patients to facilitate smooth communication and resolution of issues.

Qualifications

• Extensive knowledge and experience with major medical and pharmacy benefit coverage.
• 2 to 3 years of experience conducting benefit investigations, including analyzing and interpreting insurance policies.
• 2 to 3 years of direct interaction with healthcare providers regarding health insurance plan requirements.
• Strong verbal communication skills with excellent grammar.
• Experience using Salesforce CRM preferred.

Compensation and Benefits

• Hourly pay between $20 and $25.
• Initial onsite work required at 495 N Keller Rd, Maitland, FL 32751, with potential for hybrid or remote arrangements after meeting certain criteria.
• Comprehensive medical, dental, vision, life, and short-term disability insurance coverage.
• Access to telehealth services for medical insurance plan enrollees.
• Competitive salary structure with matching 401(k) and immediate vesting.
• Legal insurance provided.
• Supportive, forward-thinking, and fast-paced work environment promoting work-life balance and inclusivity.
• Preloaded PTO starting at 100 hours (12.5 days), increasing to 140 hours (17.5 days) after one year; additional tenure bonuses of $1,000 at 3 years and $2,500 at 5 years.
• Award programs recognizing peer-nominated excellence, adherence to company values (Excellence, Winning, Respect, Inspiration, Teamwork), and visionary contributions to patient access.
• $750 referral bonus available if you recommend a successful hire.

Additional Information

AssistRx is an equal opportunity employer that ensures all applicants are evaluated without discrimination based on race, religion, gender identity, sexual orientation, age, disability, or other protected characteristics. Employment offers are contingent upon successful background checks, and compliance with federal employment eligibility verification is required. This role does not provide sponsorship or work authorization support. Unsolicited resumes from external agencies will not be accepted or compensated.