Lead Insurance Resolution Specialist – Hybrid/Remote

Pantherx Specialty LLC; Pittsburgh (Allegheny County); Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401K with employer matching

Paid time off

Paid holidays

Job summary

Pantherx Specialty LLC in Pittsburgh, PA, seeks a Lead Insurance Resolution Specialist on the second shift to verify patient insurance coverage and enter benefit information into the RxARECARE system. You will work with the supervisor, handle multiple drugs, and support staffing and training as needed.

This role requires a bachelor’s degree, strong communications, and solid knowledge of medical and pharmacy payer processes.

Qualifications

• Bachelor’s degree in business or related field; equivalent experience accepted.
• Detailed understanding of medical and pharmacy insurance verification across payer types.
• Excellent written and verbal communication skills; able to work with all management levels.
• Knowledge of Microsoft Office Suite; Excel, Outlook, and PowerPoint are a plus.
• Ability to work independently with tact and professional judgment.

Responsibilities

• Verifies pharmacy and medical insurance benefit coverage for newly referred patients.
• Acts as liaison between staff and supervisors to address day-to-day questions.
• Assists with training or retraining of staff as needed.
• Manages multiple drug processes to provide temporary staffing relief.
• Works on special projects and monitors daily reports to meet objectives.
• Follows up with payors, physician offices, and patients for authorizations.
• Submits authorizations and payer overrides for drugs, nursing, and per diem charges.
• Researches authorization approvals, denials, and appeals.
• Processes claims via NCPDP and resolves rejections until payable.
• Re-verifies insurance at shipment and assists with enrollments into co-pay programs.

Skills

Communication

Problem-solving

Independent work

Microsoft Office

Excel

Education

Bachelor’s degree in business

Tools

Cover My Meds

Job description

Pantherx Specialty LLC in Pittsburgh, PA, seeks a Lead Insurance Resolution Specialist on the second shift to verify patient insurance coverage and enter benefit information into the RxARECARE system. You will work with the supervisor, handle multiple drugs, and support staffing and training as needed.

This role requires a bachelor’s degree, strong communications, and solid knowledge of medical and pharmacy payer processes.