
Insurance Claim Resolution Specialist
7 days ago
Our team is seeking a highly skilled professional to fill the Insurance Verification Specialist role. This key position plays a vital part in our company’s mission to provide efficient solutions for life sciences companies, ultimately improving patient outcomes.
Job Summary:- The successful candidate will work closely with healthcare providers and insurance plans to verify patient insurance coverage and navigate complex reimbursement issues.
Key Responsibilities:
- Ensure cases are processed efficiently, adhering to established standards and procedures.
- Conduct benefit investigations by making outbound calls to payers, verifying patient insurance benefits, and resolving reimbursement barriers.
- Verify patient-specific benefits, document details, and identify coverage restrictions.
- Initiate prior authorization and claims appeals processes.
- Provide regular updates on reimbursement trends and delays to management.
Requirements:
- Deep understanding of insurance policies, including Buy & Bill, Major Medical, and Pharmacy Benefit Coverage.
- Minimum 2-5 years of experience in benefit investigation, analyzing and interpreting insurance coverage.
- 3-5 years of experience interacting with healthcare providers regarding health insurance plan requirements.
- Excellent verbal communication skills and grammar.
- Proficient computer skills and Salesforce system experience preferred.
We offer a supportive and progressive environment, competitive compensation package, and comprehensive benefits.
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