Benefit Investigation Specialist

This posting is for a contract assignment and is not a full-time employment offer with ConnectiveRx. Candidates selected for roles will be employed as contract workers through a Boeing approved 3rd party for the duration of the specified project.

Duties
Responsible for direct contact with Medical Insurance Payers and Pharmacy Benefit Managers in order to identify and document available coverage options for retail and specialty medications. Maintains high quality customer service standards in compliance with federal and state regulations and guidelines.

What you will do:

* Makes outbound calls to Payers and Pharmacy Benefit Manager in order to verify patient insurance coverage and identify available Medical and Pharmacy benefits
* Communicates case details to appropriate internal or external parties once benefit verification is complete
* Identify any payer coverage restrictions and potential mechanisms for quickly accessing therapy
* Ability to effectively contribute alone or in small work groups
* Effectively meets production and time completion goals
* Accurately document payer Prior Authorization and Appeals protocols
* Participate in special projects and perform additional duties as required
* Maintain repository of payer or brand specific coverage information
* Participate in training and process improvement initiatives

What you will do:

* Makes outbound calls to Payers and Pharmacy Benefit Manager in order to verify patient insurance coverage and identify available Medical and Pharmacy benefits
* Communicates case details to appropriate internal or external parties once benefit verification is complete
* Identify any payer coverage restrictions and potential mechanisms for quickly accessing therapy
* Ability to effectively contribute alone or in small work groups
* Effectively meets production and time completion goals
* Accurately document payer Prior Authorization and Appeals protocols
* Participate in special projects and perform additional duties as required
* Maintain repository of payer or brand specific coverage information
* Participate in training and process improvement initiatives

Skills
* Minimum of 2 years' experience in customer service, insurance, benefits, marketing, sales, or related area, required, or Bachelor's degree and 1 year of relevant experience
o Health care environment with third party benefits verification experience preferred.
* Understanding of commercial insurance concepts including coverage policies, major medical benefits, knowledge of government and patient assistance program, knowledge of and understanding of how to communicate information on health insurance, reimbursements, third party terms and medical terminology is preferred
* Ability to write routine reports and correspondence using computer applications. Excellent verbal skills and knowledge of medical terms.
* Ability to work efficiently in Microsoft Office, including the creation of spreadsheets in Excel and the ability to take notes via computer keyboard during telephone conversations.
* Skill in managing email correspondence and personal documentation of research.
* Focus on fundamental analytic and problem-solving skills.
* Excellent time management skills
* Strong professional customer services experience
* High level of attention to detail
* Be a critical thinker who is adaptable, and results driven.

Education
High school diploma or equivalent, required. Bachelor's degree preferred

*Optional Benefits: Medical, Dental, Vision, 401K

Tundra Technical Solutions is among North America's leading providers of Staffing and Consulting Services. Our success and our clients' success are built on a foundation of service excellence. We are an equal opportunity employer, and we do not discriminate on the basis of race, religion, color, national origin, sex, sexual orientation, age, veteran status, disability, genetic information, or other applicable legally protected characteristic. Qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law, including the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Unincorporated LA County workers: we reasonably believe that criminal history may have a direct, adverse and negative relationship with the following job duties, potentially resulting in the withdrawal of a conditional offer of employment: client provided property, including hardware (both of which may include data) entrusted to you from theft, loss or damage; return all portable client computer hardware in your possession (including the data contained therein) upon completion of the assignment, and; maintain the confidentiality of client proprietary, confidential, or non-public information. In addition, job duties require access to secure and protected client information technology systems and related data security obligations.