Specialist, Medical Insurance II

Specialist, Medical Insurance II

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Heredia, Heredia Province

1. Function: Operations

2. Work location type: Hybrid

3. Job Type Full-time

Job ID: R68220296

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Company Description

About AbbVie

AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas including immunology, oncology and neuroscience - and products and services in our Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at www.abbvie.com. Follow @abbvie on LinkedIn, Facebook, Instagram, X and YouTube.

Job Description

The Insurance Specialist II acts as the primary point of contact for Health Care Providers (HCPs) and patients when addressing complicated patient access challenges. This position will be a subject matter expert in insurance, prior authorizations, best-in-class customer service, and alternate funding options . The position addresses issues and concerns to provide HCPs and patients with accurate explanations of patients’ medical and/or pharmacy benefits, financial assistance, and access questions. Additionally, this position enables the productivity of the broader access team by building, maintaining and providing access to the insurance intelligence.

Responsibilities :

Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution. Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products. Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions. Clearly communicate and educate customers on results of the investigation Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges or non-preferred formulary issues. Where necessary, complete a benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor. Quickly learn and execute business process and system changes for all drugs and channel sources as applicable. Maintain an understanding of current business procedures, deviations, and case processing for all brands and channel sources for Insurance Specialist I role to support as needed. Documents information in the appropriate system of recordand formats. Accurately communicate insurance details to HCP and patients via phone, other electronic communication methods and fax, as per established policies and procedures. Identify potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations. Support changing business priorities by being flexible in executing or overseeing completion of specific tasks to support the patients, products, or services we provide for all current and new products. Work cross-functionally to identify and share opportunities for process and productivity improvements. Liaise between healthcare providers, insurance companies, AbbVie Patient Access Support field rep.s, Ambassadors, filling pharmacies and patients to administer the Patient Support Service programs. Educate healthcare providers, AbbVie Patient Access Support field representatives, filling pharmacies, and patients on access processes specific to their patient's insurance plan. Meet or exceed department standards relative to performance metrics. Maintain a work environment that upholds privacy standards required by law and AbbVie policy. Act as a resource for the Training department including providing support for training curriculum and new hires. Provide side by side coaching and assistance for Insurance Specialist Level 1s. Successfully complete role based training requirements, including passing certifications and competency assessments prior to conclusion of training period. Understand and comply with all required training, including adherence to federal, state, and local laws, SPII policies and guidelines, and the policies and procedures of AbbVie Access Support and AbbVie. Perform additional tasks, activities, and projects as deemed necessary by management

Qualifications

• High school diploma or GED equivalent required. Degree preferred.
• 2-4 years of work experience in a healthcare or reimbursement setting; previous experience in a call center environment, healthcare office, or specialty pharmacy preferred.
• Must have a thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations.
• Must be experienced and knowledgeable in Medicare Part D, Medicaid and alternate funding resources, private payers, pharmacy benefits, and medical benefits.
• Demonstrated ability to lead and participate within a team, manage multiple priorities and meet associated timelines while maintaining accuracy. Proven leadership skills.
• Professional written and verbal communication skills are required.
• Ability to maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers.
• Demonstrated strong, accurate technical skills. Must be detail oriented.
• Proven organizational and problem-solving skills, elevating to management when appropriate.
• Skilled with the use of the Microsoft Office suite, and the ability to use and effectively learn and navigate other computer systems.

Additional Information

At AbbVie, we are committed to cultivating a workplace culture that promotes inclusion, diversity, and personal growth. We recognize that our collective success is based on the individual well-being of our employees, which is why we have designed a benefits package that considers every aspect of their lives.

• Enhanced Health and Wellness Coverage: Our administrative staff enjoys comprehensive medical and dental insurance, ensuring peace of mind for you and your loved ones.
• Extended Vacation: We believe in the balance between work and personal life for our administrative team. That’s why we offer additional vacation days, beyond legal requirements.
• Flexible Hybrid Work Model: For eligible positions within our administrative staff, we have adopted a hybrid work scheme allowing the convenience of working from home two days a week.
• Life Insurance: Secure your family’s future with our life insurance policy.
• Employee Assistance Program (EAP): Access professional support with our comprehensive EAP, offering psychological, legal, and financial counseling.
• On-Site Health Services: Benefit from the convenience of having a company doctor and physical therapy services, demonstrating our commitment to your health and well-being.
• Community and Social Engagement: Make a difference with a paid volunteer day, allowing you to contribute to the community during company working hours.
• Special Leave Benefits: Celebrate your life achievements with extra leave days for marriage and enjoy your birthday with a day off.
• Employee Stock Purchase Plan: Participate in our company's success by purchasing shares at a special price exclusive to employees.
• Transportation and Meals subsidized.
• Solidary Association: Join a community focused on mutual help and enjoy the benefits that come with being a member.

AbbVie is an equal opportunity employer and is committed to operating with integrity, driving innovation, transforming lives and serving our community.  Equal Opportunity Employer/Veterans/Disabled.

US & Puerto Rico only - to learn more, visit https://www.abbvie.com/join-us/equal-employment-opportunity-employer.html

US & Puerto Rico applicants seeking a reasonable accommodation, click here to learn more:

https://www.abbvie.com/join-us/reasonable-accommodations.html

Recruitment Fraud Alert

We have recently become aware of various recruitment phishing scams targeting job seekers. Please be advised:

• AbbVie will never request sensitive personal information (such as bank account details, social security numbers, or payment of any kind) during the recruitment process.
• If you suspect you have received a fraudulent offer or communication claiming to be from AbbVie, please do not respond, open any attachments, or click on any hyperlinks.

If you have any questions or concerns regarding the authenticity of a communication alleged to have been made by or on behalf of AbbVie, please contact us immediately.

Protect yourself by verifying job offers and communications. Your safety is important to us.

Pay Range: $

Where We Work

Role is primarily site- or office-based but can occasionally be performed remotely. Employees who are site/office-based and can occasionally perform their role virtually work both in the office and remotely*, following the policies and regulations in place at their location. US Employees must be in the office on Tuesday, Wednesday, and Thursday with flexibility to work remotely on Mondays and Fridays. Three days in the office is the minimum; some individuals or teams may require more in-office days due to meetings, business/project needs or their role.

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