Insurance Specialist II
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Job Description
Insurance Specialist II helping AbbVie patients and healthcare providers navigate coverage, prior authorizations, and funding. Resolving complex access issues and supporting patient assistance programs.
Responsibilities:
- Serve as the primary point of contact for healthcare providers and patients facing complicated patient access challenges
- Provide insurance coverage, verification details, prior authorization status, and alternate funding options
- Supply offices with current plan forms, portals, and websites for prior authorizations and appeals
- Communicate and educate customers on investigation results and insurance access processes
- Investigate and resolve escalated access issues, savings/copay card challenges, and non-preferred formulary issues
- Complete benefit investigations and contact healthcare providers, patients, pharmacies, and payors as needed
- Learn and execute business process and system changes for drugs and channel sources
- Document information accurately in the appropriate systems and formats
- Communicate insurance details through phone, electronic communication, and fax
- Identify potential adverse events for Pharmacovigilance reporting in accordance with FDA regulations
- Support changing business priorities and tasks for current and new products
- Collaborate cross-functionally on process and productivity improvements
- Liaise among healthcare providers, insurers, AbbVie field representatives, filling pharmacies, and patients
- Meet or exceed department performance metrics
- Maintain privacy-compliant work practices
- Support the Training department and coach Insurance Specialist I employees
- Complete role-based training, certifications, and competency assessments
- Comply with applicable laws, SPII guidelines, and AbbVie policies
- Perform additional tasks and projects assigned by management
Requirements:
- 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, healthcare office, or specialty pharmacy preferred
- Knowledge of commercial and government pharmacy and medical insurance programs
- Knowledge of billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations preferred
- Experience with Medicare Part D, Medicaid, alternate funding resources, private payers, pharmacy benefits, and medical benefits preferred
- Ability to lead and participate within a team, manage multiple priorities, meet timelines, and maintain accuracy
- Proven leadership skills
- Professional written and verbal communication skills
- Ability to maintain a positive service image when handling challenging issues and unsatisfied customers
- Strong and accurate technical skills
- Detail-oriented
- Organizational and problem-solving skills
- Proficiency with Microsoft Office and ability to learn and navigate other computer systems
- Must complete required training, certifications, and competency assessments
- Must comply with applicable federal, state, and local laws and AbbVie policies
Benefits:
- Paid time off including vacation, holidays, and sick leave
- Medical, dental, and vision insurance
- 401(k)
- Eligibility to participate in short-term incentive programs
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