Benefit Investigation Specialist

Jobtailor; Pittsburgh (Allegheny County); On-site; USD 42,000 - 62,000; Full time

Job summary

Jobtailor in Pittsburgh seeks a dedicated Insurance Verification Specialist to verify patient insurance coverage with payers and PBMs, uncover available benefits, and document case details for efficient access to therapy. You’ll work in a team or independently to meet deadlines while ensuring top‑notch service.

The role emphasizes accurate documentation, knowledge of coverage policies, and familiarity with government and patient assistance programs, in a healthcare setting.

Qualifications

• High school diploma or equivalent required.
• Bachelor's degree preferred.
• Minimum of 2 years of experience in customer service, insurance, benefits, marketing, sales, or a related area required, or a Bachelor's degree with one year of relevant experience.
• Preferred experience in a healthcare environment focusing on third‑party benefits verification.
• Understanding of commercial insurance concepts, including coverage policies and major medical benefits.
• Knowledge of government and patient assistance programs.
• Highly proficient in computer skills, including Microsoft tools and working from dual monitors.
• Strong email correspondence and personal documentation skills.
• Fundamental analytic and problem‑solving skills.
• Excellent time management.
• Demonstrated professional customer service experience with high attention to detail.
• Critical thinking, adaptability, and results‑driven approach.
• Ability to comply with federal and state regulations.

Responsibilities

• Connect with payers and Pharmacy Benefit Managers via outbound calls to verify patient insurance coverage
• Uncover available medical and pharmacy benefits for retail and specialty medications
• Communicate case details to relevant internal or external parties
• Identify payer coverage restrictions and potential mechanisms for quick access to therapy
• Work independently or in small workgroups
• Meet production and time completion goals while maintaining high-quality customer service standards
• Accurately document payer Prior Authorization and Appeals protocols
• Participate in special projects and perform additional duties as required
• Maintain a comprehensive repository of payer- or brand-specific coverage information
• Engage in training and process improvement initiatives

Skills

Customer Service

Analytic and Problem-Solving Skills

Time Management

Attention to Detail

Adaptability

Results-Driven

Email Correspondence Skills

Critical Thinking

Education

High school diploma or equivalent

Bachelor's degree preferred

Tools

Microsoft Tools

Dual Monitors

Job description

Job Responsibilities

• Connect with payers and Pharmacy Benefit Managers via outbound calls to verify patient insurance coverage
• Uncover available medical and pharmacy benefits for retail and specialty medications
• Communicate case details to relevant internal or external parties
• Identify payer coverage restrictions and potential mechanisms for quick access to therapy
• Work independently or in small workgroups
• Meet production and time completion goals while maintaining high-quality customer service standards
• Accurately document payer Prior Authorization and Appeals protocols
• Participate in special projects and perform additional duties as required
• Maintain a comprehensive repository of payer- or brand-specific coverage information
• Engage in training and process improvement initiatives

Requirements

• High school diploma or equivalent required
• Bachelor's degree preferred
• Minimum of 2 years of experience in customer service, insurance, benefits, marketing, sales, or a related area required, or a Bachelor's degree with one year of relevant experience
• Preferred experience in a healthcare environment focusing on third‑party benefits verification
• Understanding of commercial insurance concepts, including coverage policies and major medical benefits
• Knowledge of government and patient assistance programs
• Highly proficient in computer skills, including Microsoft tools and working from dual monitors
• Strong email correspondence and personal documentation skills
• Fundamental analytic and problem‑solving skills
• Excellent time management
• Demonstrated professional customer service experience with high attention to detail
• Critical thinking, adaptability, and results‑driven approach
• Ability to comply with federal and state regulations

Core Competencies

Demonstrates expertise in patient insurance coverage verification and third‑party benefits, with a strong focus on customer service and compliance with regulations. Proficient in documentation and communication, ensuring accurate case details and effective collaboration.

Highest-signal resume keywords

• Patient Insurance Coverage Verification
• Third-Party Benefits Verification
• Customer Service Experience
• Analytic And Problem-Solving Skills
• Microsoft Tools Proficiency

Hard Skills

• Insurance Concepts
• Coverage Policies
• Medical Benefits
• Prior Authorization Protocols
• Appeals Protocols
• Documentation Skills
• Time Management
• Critical Thinking

Soft Skills

• Attention To Detail
• Adaptability
• Results-Driven Approach
• Email Correspondence Skills

Industry Keywords

• Healthcare Environment
• Government Assistance Programs
• Patient Assistance Programs

Tools & Technologies

• Microsoft Tools
• Dual Monitors