Senior Insurance Specialist – Clinical Trials
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Job Description
Senior Insurance Specialist coordinating clinical-trial insurance coverage for City of Hope, a cancer and life-threatening illness care system. Leading benefit verification, authorizations, and team operations for research patients nationwide.
Responsibilities:
- Help oversee daily activities of the Research Insurance Specialist team, including assignments, scheduling coverage, onboarding, training, quality monitoring, coaching, and productivity tracking.
- Serve as a team resource and liaison when Research Patient Access leadership is unavailable, and participate in workgroups, committees, special projects, and team meetings.
- Review clinical trial billing grids and budgets to identify standard-of-care procedures and determine whether upcoming services require insurance authorization.
- Verify hospital and professional insurance benefits for clinical trial patients through telephone, mail, fax, and online inquiries.
- Enter and maintain accurate policy benefit, coverage, and authorization information in applicable systems and the medical record.
- Coordinate with research nurses, case managers, financial counselors, referral teams, registration, clinics, providers, and insurance carriers to obtain timely authorizations and pre-certifications.
- Request authorization extensions or new authorizations to support continuity of care when services or coverage change.
- Interpret managed care contract summaries, respond to coverage questions, support denial reviews and appeals, and help resolve outstanding account issues.
- Deliver exceptional service to patients, providers, colleagues, and leaders while managing multiple priorities and taking prompt action on high-priority situations.
- Maintain productivity, accuracy, confidentiality, and compliance with departmental and City of Hope policies, procedures, and standards.
Requirements:
- Associate degree, or equivalent experience in place of the minimum education requirement.
- Five years of related experience, including at least three years of healthcare experience.
- Strong customer service, communication, organization, problem-solving, and workload-management skills.
- Ability to work independently with limited supervision and collaboratively within a team environment.
- Proven ability to manage competing priorities, work toward measured goals, delegate workload, and remain professional under pressure.
- Detail-oriented, flexible, persuasive, accountable, and committed to integrity.
- Proficiency in Microsoft software and a range of PC applications.
- Bachelor’s degree preferred.
- Healthcare insurance authorization experience preferred.
- Maintain confidentiality and comply with departmental and City of Hope policies, procedures, and standards.
Benefits:
- Comprehensive Benefits
- Remote work arrangement
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