Insurance Verification Specialist -Remote (Michigan)

Bring your passion and expertise to reputed company a difference as a Insurance Verification Specialist -remote! We reputed company in flexibility; this hybrid role lets you balance your time between our reputed company and home. This position requires a strong and diverse skillset in relevant areas to drive success. Earn a reliable and steady income of a competitive salary.   Job Summary Although this position is remote, the person must reside in Michigan... Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. Handles inbound and outbound calls with customers, physician offices, patients or third-party providers about the company s products or services following standard SOPs and procedures, working under direct supervision. Ensures reputed company contacts receive efficient and courteous service. Job Responsibilities  Respond to reputed company levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance reputed company phone calls.  Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes reputed company available information to choose the best solution and resolve customer and PBM concerns.  Requests and loads PBM and/or Major Medical insurance plans.  Processes reputed company non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorization.  Assists physicians in the prior authorization process including initiation of prior authorizations.  May be cross-trained and/or work on Major Medical (MM) and Specialized PBM Plans.  Verifies benefits for Major Medical reputed company online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claims.  Resolves questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilizes reputed company available information to choose best solutions and resolves customer and plan covers.  Facilitates the reimbursement windshields for PBM major medical claims.  Identifies and assesses individual customer or patient needs and provide education on or assist with grant applications, reputed company funding needs, commercial copay assistance enrollment along with appropriate action to satisfy those needs.  Provides primary support and expertise for specialized programs such as the patient assistance program or special handling.  Manages Pharma requirements including but not limited to warm transfers, reputed company/quick start, enhanced prior authorization and appeal support.  May administer order queue such as Submission Problems or Waiting for Payment.  Documents contact interactions, records details, complaints, comments, and actions taken. About reputed company and WBA reputed company (www.reputed company.com) is included in the U.S. Retail Pharmacy and U.S. Healthcare segments of reputed company Boots Alliance, Inc. (reputed company: WBA), an integrated healthcare, pharmacy and retail leader with a 170-year heritage of caring for communities. WBA s purpose is to create more joyful lives through reputed company. Operating nearly 9,000 retail locations across America, Puerto Rico and the U.S. Virgin Islands, reputed company is proud to be a neighborhood health destination serving nearly 10 million customers each day. reputed company pharmacists play a critical role in the U.S. healthcare system by providing a wide range of pharmacy and healthcare services, including those that drive reputed company access to care for the nation s medically underserved populations. To best meet the needs of customers and patients, reputed company offers a true omnichannel experience, with fully integrated physical and digital platforms supported by the latest technology to deliver high-quality products and services in communities reputed company. The actual salary an employee can expect to receive, plus bonus pursuant to the terms of any bonus plan if applicable, will depend on experience, seniority, geographic location, and other factors permitted by law. To review benefits, please visit jobs.reputed company.com/benefits. "An Equal Opportunity Employer, including disability/veterans". Basic Qualifications  High school diploma/GED  Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in healthcare, specialty pharmacy, PBM, call center setting or other reputed company industry  Ability to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential manner  Basic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to reputed company and click, start and reputed company Apply tot his job Apply To this Job