Remote Insurance Verification Specialist

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

Job summary

An established industry player is seeking a dedicated Remote Insurance Verification Specialist to join their dynamic team. In this role, you will provide exceptional customer service by managing insurance verification and prior authorization processes. Your expertise will help patients access necessary medications while ensuring compliance with healthcare regulations. This fully remote position offers a chance to make a real difference in patients' lives while working in a supportive environment. If you have a passion for healthcare and a commitment to excellence, this opportunity is perfect for you.

Benefits

Medical, Dental & Vision

401(k) Retirement Plan

Life Insurance

Short and Long-term Disability

Health Spending Account

Transportation Benefits

Employee Assistance Program

Paid Time Off

Qualifications

• 3+ years in insurance verification or prior authorization required.
• Strong technical skills and attention to detail needed.
• Experience in healthcare call center preferred.

Responsibilities

• Provide expertise on medical and prescription insurance coverage.
• Assist with prior authorizations and appeals process.
• Communicate with healthcare providers and payors effectively.

Skills

Insurance Verification

Prior Authorization

Customer Service

Technical Skills

Problem Solving

Communication Skills

Microsoft Office Suite

Education

High School Diploma or GED

Degree Preferred

Job description

Remote Insurance Verification Specialist

Remote Insurance Verification Specialist

2 days ago Be among the first 25 applicants

Description

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

• 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
• 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.
  
  
  

Additional Skills & Qualifications

• High school diploma or GED equivalent required - degree preferred.
• 3+ years of work experience in insurance verification or prior authorization
• 3+ years of healthcare call center experience (inbound calls)
• 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.
• Access to a secure and private location to work from daily. Zero tolerance policy for interruptions during the workday
• Access to fast and secure internet connection.
• Maintain a professional dress code and appearance each day.
  
  
  

Hours

• Will be ASSIGNED a shift between 7am-7pm CST. Candidates do not get to choose their shift
  
  
  

Pay And Benefits

The pay range for this position is $20.00 - $22.00/hr.

Requirements

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 Apr 30, 2025.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

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

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  IT Services and IT Consulting

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