Insurance Specialist II

About the role

The Insurance Specialist II is the primary point of contact for Health Care Providers (HCPs) and patients on complicated patient access issues. As a subject matter expert in insurance, prior authorizations, customer service and alternate funding options, the specialist explains medical and pharmacy benefits, financial assistance and access questions, and builds and maintains the insurance intelligence used by the wider access team.

Key responsibilities

• Handle inbound and outbound calls to drive first-call resolution, giving coverage, verification and prior authorization status and alternate funding options for existing and new products.
• Provide offices with current plan forms, portals and websites for prior authorizations and appeals.
• Investigate escalated cases such as disadvantaged or complex access, savings card/copay card issues and non-preferred formulary problems, contacting HCPs, patients, pharmacies or payors when needed.
• Learn and apply business process and system changes quickly, and document work accurately in the system of record.
• Communicate insurance details to HCPs and patients by phone, electronic means and fax, and report potential adverse events to Pharmacovigilance.
• Liaise with HCPs, insurers, field reps, Ambassadors, pharmacies and patients on Patient Support Service programs and access processes.
• Support training, including side-by-side coaching of Insurance Specialist I and completing role-based training and certifications.
• Meet department performance standards, protect patient data privacy and comply with federal, state and local laws and AbbVie policies.

Required profile

• High school diploma or GED; degree preferred.
• 2-4 years of experience in healthcare or reimbursement settings; call center, healthcare office or specialty pharmacy experience preferred.
• Knowledge of commercial and government pharmacy and medical insurance, billing, reimbursement, prior authorization and appeal filings, and specialty pharmacy operations.
• Experience with Medicare Part D, Medicaid, private payers, pharmacy benefits and medical benefits.
• Team player with leadership skills, strong written and verbal communication, attention to detail and organizational skills.

Required skills

• Microsoft Office suite
• Ability to learn and navigate other computer systems

What we offer

• Comprehensive medical and dental insurance for administrative staff
• Additional vacation days and a hybrid model (two days a week from home where eligible)
• Life insurance, employee assistance program, on-site health services and a paid volunteer day
• Extra leave for marriage and a day off on your birthday, employee stock purchase plan, and subsidized transportation and meals