Specialist, Medical Insurance II

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