Payer & PBM Benefit Verification Specialist (6M Contract)

Smart IMS Inc; Pittsburgh (Allegheny County); On-site; USD 39,000 - 58,000; Full time

Job summary

Smart IMS Inc. seeks a Benefit Investigation Specialist in Pittsburgh, PA for a 6-month contract. Duties include verifying insurance coverage with payers and PBMs, documenting benefits, and ensuring compliant communications.

Ideal candidates have 2+ years in customer service or insurance, familiarity with health insurance terms, and strong MS Office skills. On-site role in Pittsburgh with full-time hours.

Qualifications

• 2+ years' experience in customer service, insurance, benefits, marketing, sales, or related area.
• Knowledge of commercial insurance concepts and government programs is preferred.
• Proficient in Microsoft Office and note-taking during calls.

Responsibilities

• Make outbound calls to Payers/Pharmacy Benefit Managers to verify insurance coverage and identify benefits.
• Communicate case details to internal or external parties after verification.
• Identify payer coverage restrictions and access mechanisms for therapy.
• Contribute effectively alone or in small work groups.
• Meet production and time-completion goals.
• Document payer Prior Authorization and Appeals protocols.

Skills

Customer service

Insurance verification

Payer communications

Documentation

Time management

Education

High school diploma

Bachelor's degree preferred

Tools

Microsoft Office

Excel

Job description

Smart IMS Inc. seeks a Benefit Investigation Specialist in Pittsburgh, PA for a 6-month contract. Duties include verifying insurance coverage with payers and PBMs, documenting benefits, and ensuring compliant communications.

Ideal candidates have 2+ years in customer service or insurance, familiarity with health insurance terms, and strong MS Office skills. On-site role in Pittsburgh with full-time hours.