Benefits Investigation Specialist

Pittsburgh, Pennsylvania

Title: Benefits investigation Specialist
Location: Pittsburgh, PA
 (Coraopolis/Moon Township)

Summary:
Responsible for direct contact with Medical Insurance Payers and Pharmacy Benefit Managers in order to identify and document available coverage options for retail and specialty medications.  
 
Responsibilities:

  • Makes outbound calls to Payers and Pharmacy Benefit Manager in order to verify patient insurance coverage and identify available Medical and Pharmacy benefits
  • Communicates case details to appropriate internal or external parties once benefit verification is complete
  • Identify any payer coverage restrictions and potential mechanisms for quickly accessing therapy
  • Ability to effectively contribute alone or in small work groups
  • Effectively meets production and time completion goals 
  • Accurately document payer Prior Authorization and Appeals protocols
  • Participate in special projects and perform additional duties as required
  • Maintain repository of payer or brand specific coverage information
  • Participate in training and process improvement initiatives

Qualifications:

  • Minimum of 2 years’ experience in customer service, insurance, benefits, marketing, sales, or related area, required, -OR- Bachelor’s degree and 1 year of relevant experience.
  • Strong professional customer services experience.
  • Excellent verbal skills.
  • Ability to work efficiently in Microsoft Office, including the creation of spreadsheets in Excel and the ability to take notes via computer keyboard during telephone conversations. 
  • Ability to write routine reports and correspondence using computer applications.
  • Excellent time management skills.
  • Health care environment with third party benefits verification experience preferred.
  • Extra/Preferred qualifications: Understanding of commercial insurance concepts including coverage policies, major medical benefits, knowledge of government and patient assistance program, knowledge of and understanding of how to communicate information on health insurance, reimbursements, third party terms and medical terminology.

Education Requirements:

High school diploma or equivalent, required.  Bachelor’s degree preferred.

About SSi People
With over 25 years of industry experience, SSi People has built its reputation and expertise on putting people first. Everything we do works toward delivering an 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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