Specialist, Insurance II

About the position

The Insurance Specialist II serves as the primary contact for Health Care Providers (HCPs) and patients, addressing complex patient access challenges. This role requires expertise in insurance, prior authorizations, and customer service, ensuring accurate communication of medical benefits and financial assistance. The specialist will also support the broader access team by maintaining insurance intelligence and providing best-in-class service to drive first call resolution.

Responsibilities

• Act as the primary point of contact for HCPs and patients regarding patient access challenges.
• Provide subject matter expertise in insurance and prior authorizations.
• Deliver best-in-class customer service for inbound and outbound calls.
• Investigate and resolve escalated patient access issues.
• Communicate insurance coverage and verification details to HCPs and patients.
• Maintain understanding of business procedures and case processing for all brands.
• Document information accurately in the appropriate systems.
• Identify potential Adverse Event situations for reporting to Pharmacovigilance.
• Support changing business priorities and execute specific tasks as needed.
• Work cross-functionally to identify opportunities for process improvements.
• Educate stakeholders on access processes specific to insurance plans.
• Meet or exceed department performance metrics.
• Act as a resource for training and support for new hires and Insurance Specialist Level 1s.

Requirements

• High school diploma or GED equivalent required; degree preferred.
• 2-4 years of work experience in a healthcare or reimbursement setting.
• Experience in a call center environment, healthcare office, or specialty pharmacy preferred.
• Understanding of commercial and government pharmacy and medical insurance programs.
• Knowledge of billing, alternate funding resources, and reimbursement processes.
• Experience with Medicare Part D, Medicaid, and private payers preferred.
• Demonstrated ability to manage multiple priorities and meet timelines accurately.
• Proven leadership skills and professional communication skills.
• Detail-oriented with strong organizational and problem-solving skills.
• Skilled in Microsoft Office and ability to learn other computer systems.

Nice-to-haves

• Experience in specialty pharmacy operations.
• Knowledge of prior authorization and appeal filings.

Benefits

• 401(k)
• Dental insurance
• Health insurance
• Paid holidays
• Paid time off
• Vision insurance