Job Title: Benefit Investigation Specialist
Location: Pittsburgh, Pennsylvania (On-Site)
Job Summary: We are recruiting for a Benefit Investigation Specialist opportunity supporting high-quality patient coverage verification and benefit research. Our team is looking for a detail-oriented professional who can help ensure accurate payer and pharmacy benefit information is documented and communicated clearly within a regulated healthcare environment.
Responsibilities:
- Make outbound calls to payers and pharmacy benefit managers to verify medical and pharmacy coverage.
- Communicate verified case details to appropriate internal or external parties in a timely manner.
- Identify coverage restrictions and document prior authorization and appeals protocols accurately.
- Support special projects, process improvement initiatives, and maintenance of payer or brand-specific coverage information.
Required:
- Minimum of 2 years of experience in customer service, insurance, benefits, marketing, sales, or a related area, or a bachelor’s degree with 1 year of relevant experience.
- High school diploma or equivalent required; bachelor’s degree preferred.
- Health care environment with third-party benefits verification experience preferred.
- Understanding of commercial insurance concepts, coverage policies, major medical benefits, government and patient assistance programs, reimbursements, third-party terms, and medical terminology preferred.
- Ability to write routine reports and correspondence using computer applications and work efficiently in Microsoft Office, including Excel.
- Strong verbal communication skills, email management, documentation, analytic and problem-solving skills, time management, attention to detail, and the ability to take notes during telephone conversations.
About SSI People: With over 26 years of industry experience, SSi People has built its reputation and expertise on putting people first. Everything we do works toward delivering exceptional experience for our consultants, our clients, and our internal team. Through a genuine commitment to people in everything we do. We have developed refined processes and a stellar internal team to deliver talent quickly. More importantly, we focus on building long-term relationships, not transactions. Putting people first is just what we do well.
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