Insurance Verification Specialist - Work-From-Home (Florida)

Job Summary

The Insurance Verification Specialist is responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. The specialist will handle 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, and working under direct supervision. Ensures all contacts receive efficient and courteous service. Duties may vary.

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.
• Process all PBM rejections which may include rejections for plan limits, coverage termed or prior authorization.
• Facilitate of reimbursement windshields for PBM major medical claims.
• Request and load insurance plans and process medical insurance referrals.
• Identifies and assesses individual customer or patient needs and provides education on or assists with grant applications and complex funding needs along with appropriate action to satisfy those needs.
• Provide primary support and expertise for specialized programs such as the patient assistance program or special handling
• Document contact interactions, records details, complaints, comments, and actions taken.
• Will participate in special projects and perform all other responsibilities as deemed necessary

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.

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
• 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 the computer, use the 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 providing customer service in a healthcare, specialty pharmacy, PBM, call center setting or other related industry including but not limited to adherence, quality, After Call Work (ACW), etc.
• Experience with Microsoft Office Suite (such as MS Word, MS Excel, etc.)
• Proficient computer skills with the ability to learn proprietary company software; experience working with multiple systems.

An employee in this position can expect an hourly rate between $15.00 and $20.00. The actual compensation offered will depend on experience, seniority, geographic location, and other factors permitted by law. To review benefits, please click here jobs.walgreens.com/benefits.