Benefit Investigation Specialist

ConnectiveRx Corporation; Pittsburgh (Allegheny County); On-site; USD 21,022 - 30,307; Full time

Benefits offered by this job

Comprehensive benefit plans

401(k) plan

Paid time off

Job summary

A health services organization in Pittsburgh is seeking a Benefits Investigation Specialist. This role involves engaging with Medical Insurance Payers and Pharmacy Benefit Managers to verify patient coverage and document options for retail and specialty medications. Candidates should have strong customer service experience along with proficiency in analytics and problem-solving. This position offers competitive pay and comprehensive benefits including health insurance and a 401(k) plan.

Qualifications

• 2 years of experience in customer service, insurance, or related fields.
• Preferred experience in a healthcare environment focused on benefits verification.
• Understanding of commercial insurance and patient assistance programs.

Responsibilities

• Verify patient insurance coverage and benefits with Payers and Pharmacy Managers.
• Document Prior Authorization and Appeals protocols accurately.
• Participate in training and process improvement initiatives.

Skills

Customer service experience

Analytic skills

Problem-solving skills

Attention to detail

Time management

Education

High school diploma or equivalent

Bachelor's degree

Tools

Microsoft tools

Job description

Overview

Being on medication is tough enough. We want to make getting it the easy part. Getting prescriptions to patients has become increasingly complex. When things get messy along the prescription journey, pharmaceutical manufacturers rely on us to untangle the process and create a clear path—allowing patients to build trusting relationships with their medication brands.

We’re not only committed to taking the pain out of the prescription process, but we’re also devoted to bringing the brightest minds together under one roof. We bring together diverse voices—engineers, pharmacists, customer service veterans, developers, program strategists and more—all with one vision. Each perspective and experience makes ConnectiveRx better than the sum of its parts.

Join our dynamic team as a Benefits Investigation Specialist and be a crucial part of ensuring access to essential medications! We seek a compassionate individual to engage with Medical Insurance Payers and Pharmacy Benefit Managers, playing a vital role in identifying and documenting coverage options for retail and specialty medications.

Responsibilities

• Connect with Payers and Pharmacy Benefit Managers via outbound calls to verify patient insurance coverage and uncover available Medical and Pharmacy benefits.
• Communicate case details to relevant internal or external parties, fostering effective collaboration.
• Identify potential mechanisms for quick access to therapy by recognizing any payer coverage restrictions.
• Showcase your ability to contribute effectively, whether working independently or in small workgroups.
• Meet production and time completion goals with a focus on maintaining high-quality customer service standards in accordance with federal and state regulations.
• Accurately document payer Prior Authorization and Appeals protocols, ensuring meticulous attention to detail.
• Participate in special projects and embrace additional duties as required, contributing to a dynamic work environment.
• Maintain a comprehensive repository of payer or brand-specific coverage information.
• Engage in training and process improvement initiatives to enhance your professional growth.

Qualifications

• A high school diploma or equivalent is required; a Bachelor's degree is preferred.
• Minimum of 2 years of experience in customer service, insurance, benefits, marketing, sales, or a related area is 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, major medical benefits, and knowledge of government and patient assistance programs.
• Highly proficient in computer skills, including Microsoft tools, working from dual monitors, etc.
• Strong email correspondence and personal documentation skills.
• Fundamental analytic and problem‑solving skills with excellent time management.
• Demonstrated professional customer service experience with high attention to detail.
• Be a critical thinker who is adaptable and results‑driven.

Compensation & Benefits: Compensation for this role varies based on factors such as location, relevant skills, experience, and capabilities.

Employees at ConnectiveRx can enroll in comprehensive benefit plans, including medical, dental, vision, life, and disability insurance. The company retains the right to update or modify health, welfare, and other fringe benefit policies. Employees may also participate in the company's 401(k) plan.

Time‑Off & Holidays: ConnectiveRx provides paid time off (PTO) to non‑exempt employees for vacations and personal leave. For sick leave, eligible non‑exempt employees receive Sick Time Off (STO) in accordance with company policy. PTO and STO are prorated during the first year of service. Employees also receive eight standard company holidays and three floating holidays annually, with floating holidays prorated in the first year.

The company is committed to maintaining competitive benefits and reserves the right to adjust employee offerings, including PTO, STO, and holiday policies, in compliance with applicable laws and regulations.

Posted Salary Range

USD $15.26 - USD $22.00 /Hr.