Role OverviewAs a Benefit Investigation Specialist, you will play a vital part in helping patients access prescribed therapies by verifying insurance eligibility and identifying available medical and pharmacy benefits. Your work directly supports reducing delays in treatment by clarifying coverage pathways and ensuring accurate, compliant documentation.
Key Responsibilities
- Conduct outbound calls to Medical Insurance Payers and Pharmacy Benefit Managers to confirm patient coverage and uncover applicable benefits.
- Communicate case updates clearly to internal teams and external partners to maintain coordination and transparency.
- Identify coverage limitations or restrictions that may affect access and determine strategies for faster therapy initiation.
- Work independently or collaboratively in small teams to meet performance and quality benchmarks.
- Adhere to federal and state compliance standards while delivering high-quality service within established timeframes.
- Record detailed procedures for Prior Authorization and Appeals processes specific to individual payers.
- Build and maintain an organized database of payer and brand-specific benefit policies.
- Support training efforts and process enhancements to improve efficiency and accuracy.
- Take on special assignments and adapt to evolving priorities in a fast-paced environment.
Required Qualifications
- High school diploma or equivalent required.
- At least two years of experience in customer service, insurance, benefits administration, sales, or a related field; or a Bachelor’s degree with one year of relevant experience.
- Proven track record in customer-facing roles with strong attention to detail.
- Basic analytical and problem-solving abilities, with effective time management skills.
- Proficiency in written communication, particularly email and case documentation.
- Advanced computer literacy, including fluency with Microsoft applications and experience working across dual monitors.
Preferred Qualifications
- Bachelor’s degree preferred.
- Experience in healthcare, particularly in third-party benefits verification, is a plus.
- Familiarity with commercial insurance structures, major medical plans, and government or patient assistance programs.
- Adaptable mindset with a focus on results and critical thinking in complex situations.
Technical Environment
Microsoft tools and dual-monitor setup are standard for this role.
Benefits
- Comprehensive medical, dental, vision, life, and disability insurance options.
- Eligibility to participate in the company’s 401(k) plan.
- Paid time off (PTO) for vacation and personal leave, with prorated accrual in the first year.
- Sick Time Off (STO) for eligible non-exempt employees, per company policy.
- Eight fixed company holidays annually, plus three floating holidays (prorated in the first year).
