Insurance Verification Specialist -Remote (Michigan)

Job Summary
Although this position is fully remote, the person in this role must reside in the state of Michigan.

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 of 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, and 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 and WBA

Walgreens (www.walgreens.com) is included in the U.S. Retail Pharmacy and U.S. Healthcare segments of Walgreens Boots Alliance, Inc. (Nasdaq: WBA), an integrated healthcare, pharmacy, and retail leader with a 170-year heritage of caring for communities.

 

WBA’s purpose is to create more joyful lives through better health. Operating nearly 9,000 retail locations across America, Puerto Rico, and the U.S. Virgin Islands, Walgreens is proud to be a neighborhood health destination serving nearly 10 million customers each day. Walgreens pharmacists play a critical role in the U.S. healthcare system by providing a wide range of pharmacy and healthcare services, including those that drive equitable access to care for the nation’s medically underserved populations.

To best meet the needs of customers and patients, Walgreens offers a true omnichannel experience, with fully integrated physical and digital platforms supported by the latest technology to deliver high-quality products and services in communities nationwide.

The actual salary an employee can expect to receive, plus a bonus under the terms of any bonus plan if applicable, will depend on experience, seniority, geographic location, and other factors permitted by law. To review benefits, please visit jobs.walgreens.com/benefits.
“An Equal Opportunity Employer, including disability/veterans”.

External Basic Qualifications

Other Jobs You May Be Interested In

  • 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).

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