Insurance Verification Specialist

TEKsystems; North Chicago (IL); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking an Insurance Analyst I to provide best-in-class customer service to patients and healthcare providers. This fully remote role involves investigating insurance benefits and processing prior authorizations to ensure patients receive necessary therapies. The ideal candidate will demonstrate strong technical skills, effective communication, and a commitment to maintaining a positive service image. Join a dynamic team dedicated to maximizing patient access to care and making a meaningful impact in the healthcare industry.

Benefits

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

Employee Assistance Program

Time Off/Leave

Qualifications

• Expertise in medical and prescription insurance coverage.
• Strong technical skills and attention to detail required.

Responsibilities

• Provide subject matter expertise on insurance verification and billing.
• Assist with prior authorizations and appeals documentation.
• Communicate with patients and healthcare providers regarding status.

Skills

insurance verification

prior authorization

call center

technical skills

professional communication

problem solving

organizational skills

Tools

Microsoft Office

Job description

*Description*
Purpose:
Describe the primary goals objectives or functions or outputs of this position.
The primary function of the Insurance Analyst I is to provides best-in-class customer services to patients Health Care Providers HCPs and their staff through referral and call management by investigating patients insurance benefits and financial assistance opportunities in addition to processing and monitoring prior authorizations to assist the patient in starting or continuing therapy. This position will be a subject matter expert in insurance billing claims processing and prior authorizations. This position liaises between departments payors and providers to comprehensively determine patients overall prescription coverage. The Insurance Analyst I handles patient requests received by phone or electronically fax Humira Complete Pro or other systems and would complete related outbound calls. This position works collaboratively with other areas of the Pharmacy to maximize patients access to care.
Must have access to a secure and private location to work from daily.

Responsibilities:
List up to 10 main responsibilities for the job. Include information about the accountability and scope.
* Provide subject matter expertise on medical and prescription insurance coverage/ verification claim billing medication prior authorization and appeal filing and alternate financial assistance opportunities. Accurately documents information in the appropriate systems and formats. Communicate the status of the referral to the physician and the patient via phone fax and/or the core pharmacy system as per established policies and procedures.
* Assist offices through the entire documentation and filing process for prior authorizations and appeals. Monitor the status to ensure a rapid turnaround resulting in procurement of the drug product for the patient.
* Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits. Obtain and confirm information to maintain Pharmacy Solutions payor intelligence resources.
* Meet or exceed department standards relative to performance metrics. Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics. Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and/or resolve situations taking ownership as needed.
* Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy. Determine whether to escalate issues/concerns to management for review guidance and resolution. Participate in quality monitoring and in identifying and reporting quality issues.
* Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information
* Understand and comply with all required training including adherence to federal state and local pharmacy laws HIPAA policies and guidelines and the policies and procedures of Pharmacy Solutions and . Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring company meets FDA regulations.
* Completes all required training and performs all functions in the position e.g. Soft Skills certification product and disease overviews. Perform additional tasks activities and projects as deemed necessary by management.
*Skills*
insurance verification, prior authorization, call center
*Top Skills Details*
insurance verification,prior authorization,call center
*Additional Skills & Qualifications*
Demonstrated strong, accurate technical skills. Must be detail oriented. Professional written and verbal communication skills required.
Ability to maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers.
Proven organizational and problem solving skills, elevating to management when appropriate.
Skilled with the use of the Microsoft Office suite and the ability to use and effectively learn and navigate other computer systems.
1. Access to a secure and private location to work from daily. Access to fast and secure internet connection.
2. Maintain a professional dress code and appearance each day.
3. Balance attendance, understanding this is the number one reason agents contracts are not extended or termed early. This includes being on time for their shift and returning from lunch as well.
4. Must have thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations.
5. Demonstrated ability to lead and participate within a team, manage multiple priorities, and meet associated timelines while maintaining accuracy.
6. Demonstrated strong, accurate technical skills.
7. Must be detail oriented.
8. Professional written and verbal communication skills required.
9. Ability to always maintain a positive service image even when dealing with challenging issues and unsatisfied customers.
*Experience Level*
Expert Level
*Pay and Benefits*
The pay range for this position is $20.00 - $22.00/hr.
Eligibility requirements apply to some benefits and may depend on your job
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
available for this temporary role may include the following:
* Medical, dental & vision
* Critical Illness, Accident, and Hospital
* 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
* Life Insurance (Voluntary Life & AD&D for the employee and dependents)
* Short and long-term disability
* Health Spending Account (HSA)
* Transportation benefits
* Employee Assistance Program
* Time Off/Leave (PTO, Vacation or Sick Leave)
*Workplace Type*
This is a fully remote position.
*Application Deadline*
This position is anticipated to close on May 10, 2025.
About TEKsystems and TEKsystems Global Services

We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.


The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.