Benefit Investigation Specialist

Smart IMS Inc; Pittsburgh (Allegheny County); On-site; USD 39,000 - 58,000; Full time

Job summary

Smart IMS Inc. seeks a Benefit Investigation Specialist in Pittsburgh, PA for a 6-month contract. Duties include verifying insurance coverage with payers and PBMs, documenting benefits, and ensuring compliant communications.

Ideal candidates have 2+ years in customer service or insurance, familiarity with health insurance terms, and strong MS Office skills. On-site role in Pittsburgh with full-time hours.

Qualifications

• 2+ years' experience in customer service, insurance, benefits, marketing, sales, or related area.
• Knowledge of commercial insurance concepts and government programs is preferred.
• Proficient in Microsoft Office and note-taking during calls.

Responsibilities

• Make outbound calls to Payers/Pharmacy Benefit Managers to verify insurance coverage and identify benefits.
• Communicate case details to internal or external parties after verification.
• Identify payer coverage restrictions and access mechanisms for therapy.
• Contribute effectively alone or in small work groups.
• Meet production and time-completion goals.
• Document payer Prior Authorization and Appeals protocols.

Skills

Customer service

Insurance verification

Payer communications

Documentation

Time management

Education

High school diploma

Bachelor's degree preferred

Tools

Microsoft Office

Excel

Job description

Job Title - Benefit Investigation Specialist
Location - Pittsburgh, PA, 15275

Duration: 6 Month contract

Shift: 8-430, 830-5, 9-5:30, 10-6:30, 11:30-8, Mon to Fri

Hours Per Week: 40

Description: Duties:

Responsible for direct contact with Medical Insurance Payers and Pharmacy Benefit Managers in order to identify and document available coverage options for retail and specialty medications. Maintains high quality customer service standards in compliance with federal and state regulations and guidelines.

What you will do:

• Makes outbound calls to Payers and Pharmacy Benefit Manager in order to verify patient insurance coverage and identify available Medical and Pharmacy benefits
• Communicates case details to appropriate internal or external parties once benefit verification is complete
• Identify any payer coverage restrictions and potential mechanisms for quickly accessing therapy
• Ability to effectively contribute alone or in small work groups
• Effectively meets production and time completion goals
• Accurately document payer Prior Authorization and Appeals protocols

Skills:

Minimum of 2 years' experience in customer service, insurance, benefits, marketing, sales, or related area, required, or Bachelor's degree and 1 year of relevant experience

• o Health care environment with third party benefits verification experience preferred.

Understanding of commercial insurance concepts including coverage policies, major medical benefits, knowledge of government and patient assistance program, knowledge of and understanding of how to communicate information on health insurance, reimbursements, third party terms and medical terminology is preferred

Ability to work efficiently in Microsoft Office, including the creation of spreadsheets in Excel and the ability to take notes via computer keyboard during telephone conversations.

Education:

High school diploma or equivalent, required. Bachelor's degree preferred