Benefit Specialist

Valeris; United States; On-site; USD 42,000 - 60,000; Full time

Job summary

Valeris in the United States is seeking a Benefits Specialist to work with patients, healthcare providers, and insurers to verify benefits, assist with enrollment, and navigate coverage gaps. The role emphasizes compliant, compassionate customer service delivered via phone and web-based channels.

You will use Valeris’ systems to process claims, support program workflows, and help patients access therapy. Ideal candidates will excel in confidentiality, communication, and problem-solving,

Qualifications

• Service minded; focus on recognizing and meeting the needs of others (especially patients and care partners).
• Clear verbal and written communication skills.
• Ability to handle personal health information with confidentiality.
• Commitment to honesty and integrity.
• Professionalism and a strong sense of proper business and customer service etiquette.
• Accountability for results.
• Ability to plan and prioritize tasks and strong attention to detail.
• Proficient emotional intelligence (ability to recognize emotions and their effects).
• Ability to manage disruptive impulses and handle potentially stressed situations.

Responsibilities

• Benefit Verification: Performing patient level benefits verifications for major medical and pharmacy plans.
• Coordinate prior authorizations per payer guidelines.
• Patient Assistance: Review enrollment forms to assess eligibility and communicate results to patient/provider.
• Assist inbound callers and provide consultative service to help patients access paid therapy.
• Utilize internal platform to complete claims processing and maintain workflows.

Skills

Service minded

Communication skills

Confidentiality

Honesty and integrity

Professionalism

Accountability

Attention to detail

Emotional intelligence

Job description

Job Description

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, ValerisTM revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visitwww.valeris.com.

A typical day in this role will include providing in-depth knowledge of our client programs by working directly with patients, healthcare providers, and insurance companies to answer inquiries, process service requests, assess benefits coverage, and manage through barriers, in a compliant manner, that stand in the way of patients and their access to therapy. The Benefits Specialist works in a dynamic and compassionate customer service role providing telephonic and web-based, where applicable, customer service support.

Key Responsibilities:

The responsibilities include, but are not limited to the following:

• Benefit Verification:
  • Performing patient level benefits verifications as applicable for all major medical and pharmacy benefits plans.
  • Completion of the template forms that provide patient level benefits Coverage Determination Summary.
  • Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance.
• Patient Assistance:
  • Review of patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOPs and program guidelines.
  • Determination of patient’s eligibility based upon program criteria for qualification.
  • Communicating the patient’s eligibility to the patient, healthcare provider, and/or consignment pharmacy.
  • Answer and assist inbound callers through resolution utilizing answers to frequently asked questions or by warm transferring callers to other appropriate individuals.
  • Actively listen to each customer, assess needs, and respond with demonstrated patience and courtesy.
  • Review and identification of information that is missing and/or incorrect within program service requests/program applications.
  • Reporting of Adverse Events/ Product Complaint inquiries received in accordance with SOP and good manufacturer practices.
  • Provides timely feedback to the company regarding service failures or customer concerns
  • Effectively uses our internal technology platform, PharmaCord Lynk, to complete claims processing and keep workflows moving.
  • Communicate with key medical practice accounts, sales representatives regarding the status of cases. Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy.
  • Benefits Specialists are expected to be patient focused and committed to providing the highest quality customer service all while maintaining a sense of compliance and commitment to abiding by company policies and procedures.
  • Utilize Valeris’ values as the driving force behind the team’s success
  • On time adherence to training deadlines for all corporate policies and procedures
  • Ensure all SOPs are followed with consistency
  • Perform additional tasks or projects as assigned

Qualifications:

The candidate must possess the following personal attributes:

• Service minded; focus on recognizing and meeting the needs of others (especially patients and care partners)
• Ability to handle personal health information with confidentiality
• Commitment to honesty and integrity
• Professionalism and a strong sense of proper business and customer service etiquette
• Clear verbal and written communication skills
• Accountability for results
• Ability to plan and prioritize tasks and strong attention to detail
• Proficient emotional intelligence (ability to recognize emotions and their effects)
• Ability to manage disruptive impulses and handle potentially s