Insurance Claim Resolution Specialist

7 days ago


Maitland, New South Wales, Australia beBeeReimbursement Full time $90,000 - $120,000

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:

  1. Ensure cases are processed efficiently, adhering to established standards and procedures.
  2. Conduct benefit investigations by making outbound calls to payers, verifying patient insurance benefits, and resolving reimbursement barriers.
  3. Verify patient-specific benefits, document details, and identify coverage restrictions.
  4. Initiate prior authorization and claims appeals processes.
  5. Provide regular updates on reimbursement trends and delays to management.

Requirements:

  1. Deep understanding of insurance policies, including Buy & Bill, Major Medical, and Pharmacy Benefit Coverage.
  2. Minimum 2-5 years of experience in benefit investigation, analyzing and interpreting insurance coverage.
  3. 3-5 years of experience interacting with healthcare providers regarding health insurance plan requirements.
  4. Excellent verbal communication skills and grammar.
  5. 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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