Remote Insurance Verification Specialist, Specialty (Michigan)

Address: Remote

Job ID 1827336BR

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Job Summary:

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 all contacts receive efficient and courteous service.

Job Responsibilities:

• Respond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls.
• Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes all available information to choose the best solution and resolve customer and PBM concerns.
• Requests and loads PBM and/or Major Medical insurance plans.
• Processes all 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 via 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 all 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, complex 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, bridge/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 Walgreens

Founded in 1901, Walgreens ( proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

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 related 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 point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).

Preferred Qualifications

• Experience with providing customer service related to adherence, complex disease states quality, After Call Work (ACW), etc.
• Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
• Intermediate 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 point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).

We will consider employment of qualified applicants with arrest and conviction records.

The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits

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Remote

Skills:
Biotech and Pharmaceutical, Call Centers, Co-Payments, Communication Skills, Compensation and Benefits, Computer Mouse Hardware, Computer Skills, Customer Satisfaction, Customer Support/Service, Disease, FDA (Food and Drug Administration), Funding, Futures, Geography, Grant Writing, Health Insurance, Health Plan, Healthcare, Healthcare Providers, High School Diploma, Identify Issues, Interpersonal Skills, Medical Assistance, Medical Office, Medical Treatment, Microsoft Office, Microsoft Windows Operating System, Patient Assessment, Patient Education, Pharmacy, Presentation/Verbal Skills, Problem Solving Skills, Quality Metrics, Reimbursement, Requirements Management, Retail, Standard Operating Procedures (SOP), Startup

Walgreen Co

Founded over a century ago in 1901, we have a rich and colorful history of continuous improvement and innovation at Walgreens. From inventing the world’s first chocolate malted milkshake to the creation of one of the most popular and sophisticated mobile applications in retail shopping today, we have transformed ourselves into a leader within the retail and drug industry. Walgreens, one of the nation’s largest drugstore chains, is included in the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc., the first global pharmacy-led, health well being enterprise. At Walgreens you'll find a team positively energized by the unique talents, ideas, experiences and aspirations of every individual. In other words, you can be your authentic self in our stores, offices and other workplaces, and be comfortable and confident that what matters most here is doing your best to make health and well-being within reach for everyone on a daily basis. Walgreens has a proud legacy of valuing diversity and fostering inclusion more than 100 years-strong, and we're still living that commitment. We intend to be recognized as a “Next Practices” company for diversity and inclusion – one whose cultures, people, perspectives and workplaces reflect the current and future customers we serve while delivering superior business performance. Walgreens has over 9,500 stores in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.

Company Size:
10,000 employees or more

Industry:
Retail

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