Benefit Verification Specialist - BioPlus Specialty Pharmacy

Elevance Health; Mason (OH); Hybrid; USD 32,000 - 52,000; Full time

Job summary

BioPlus Specialty Pharmacy, part of the Elevance Health family, is seeking a Benefit Verification Specialist. This role primarily verifies patient insurance coverage for medical and pharmacy benefits, loads insurance details, and coordinates benefits with care teams.

The position supports prior authorizations and enrollment in financial assistance programs, ensuring accurate patient information and compliant processing in a hybrid in-office/remote environment.

Qualifications

• Requires HS Diploma or GED and 1 year of pharmacy or insurance verification experience.

Responsibilities

• Communicate with insurance providers, healthcare teams, and patients to gather and confirm benefit information (coverage, copays, deductibles, authorization requirements).
• Support prior authorizations, appeals, and enrollment in financial assistance programs.
• Ensure accurate patient setup in the system, monitor referrals, submit and follow up on authorization requests, and document findings for operations.
• Inform patients about coverage status, financial obligations, and next steps.
• Resolve inquiries efficiently, aiming for first-call resolution while maintaining compliance and patient confidentiality.
• Collaborate with pharmacy teams and providers to ensure timely medication access and proper claim processing.

Education

HS Diploma or GED

Job description

Benefit Verification Specialist - BioPlus Specialty Pharmacy

Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Hours: 11am -7:30pm or 11:30am-8pm EST

BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.

TheBenefit Verification Specialist - BioPlus Specialty Pharmacywill be responsible for accurately reviewing, verifying, and documenting patient insurance coverage for both medical and pharmacy benefits. This includes loading insurance details, coordinating benefits, and running test claims to confirm coverage and reimbursement outcomes.

How you will make an impact:

• Communicating with insurance providers, healthcare teams, and patients to gather and confirm benefit information such as coverage, copays, deductibles, and authorization requirements.

• Support prior authorizations, appeals, and enrollment in financial assistance programs.

• Ensure accurate patient setup in the system, monitoring referrals, submitting, and following up on authorization requests, and documenting all findings for operational use.

• Inform the patient regarding their coverage status, financial obligations, and next steps.

• Resolve inquiries efficiently, aiming for first-call resolution, while maintaining compliance with regulations and patient confidentiality standards.

• Collaboration with pharmacy teams and providers to ensure timely medication access and proper claim processing.

Minimum Requirements:

• Requires HS Diploma or GED and 1 year of pharmacy or insurance verification experience.

Preferred Skills, Capabilities and Experiences:

• Pharmacy Tech lic or certification highly desired.

• Specialty Pharmacy experience preferred.

• Pharmacy and Medical claim research experience preferred.

• Copay card and/or manufacturing experience preferred.

• Call center experience preferred.

• General knowledge of company pharmacy services, products, insurance benefits, contracts, and claims preferred.

• Experience with Medicare (Parts A–D) and specialty pharmacy is preferred.

#EHS

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.