Insurance Verification Specialist

Walgreens; Orlando (FL); On-site; USD 23,000 - 30,000; Full time

Job summary

Walgreens is a national retail and healthcare company seeking a qualified candidate to support patient eligibility verification, benefits coordination, and test claims processing. You will handle inbound and outbound calls with customers, physicians, patients, and third-party providers according to SOPs and under supervision.

Responsibilities include assisting in prior authorizations, loading plans, resolving PBM or Major Medical concerns, and providing education on patient assistance when

Qualifications

• High school diploma or GED required.
• Experience delivering customer service in healthcare, PBM, or call center settings.
• Clear, effective written and verbal communication needed.
• Basic PC skills and familiarity with MS Windows and MS Office.

Responsibilities

• Respond to inbound PBM and major medical insurance related calls.
• Resolve questions following SOPs and guidelines to provide best solutions.
• Request and load PBM and Major Medical plans.
• Process non-clinical PBM rejections and prior authorization issues.
• Assist physicians in prior authorization processes.
• Verifies benefits via online resources or phone and reviews guidelines for payment accuracy.
• Document interactions and actions taken with customers and plans.

Skills

Customer service

Communication

Interpersonal skills

Problem solving

Education

High School Diploma or GED

Tools

MS Windows

MS Office Suite

Job description

Job Summary:

Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. Handles inbound and outbound calls with customers, physician offices, patients or third-party providers about the company’s products or services following standard SOPs and procedures, working under direct supervision. Ensures all contacts receive efficient and courteous service.

Job Responsibilities:

• Respond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls.
• Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes all available information to choose the best solution and resolve customer and PBM concerns.
• Requests and loads PBM and/or Major Medical insurance plans.
• Processes all non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorization.
• Assists physicians in the prior authorization process including initiation of prior authorizations.
• May be cross-trained and/or work on Major Medical (MM) and Specialized PBM Plans.
• Verifies benefits for Major Medical via online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claims.
• Resolves questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilizes all available information to choose best solutions and resolves customer and plan covers.
• Facilitates the reimbursement windshields for PBM major medical claims.
• Identifies and assesses individual customer or patient needs and provide education on or assist with grant applications, complex funding needs, commercial copay assistance enrollment along with appropriate action to satisfy those needs.
• Provides primary support and expertise for specialized programs such as the patient assistance program or special handling.
• Manages Pharma requirements including but not limited to warm transfers, bridge/quick start, enhanced prior authorization and appeal support.
• May administer order queue such as Submission Problems or Waiting for Payment.
• Documents contact interactions, records details, complaints, comments, and actions taken.

About Walgreens

Founded in 1901, Walgreens (www.walgreens.com) proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

Basic Qualifications

• High school diploma/GED
• Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in healthcare, specialty pharmacy, PBM, call center setting or other related industry
• Ability to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential manner
• Basic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).

Preferred Qualifications

• Experience with providing customer service related to adherence, complex disease states quality, After Call Work (ACW), etc.
• Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
• Intermediate level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).

We will consider employment of qualified applicants with arrest and conviction records. The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled.

Salary Range: $16.5 - $22 / Hourly