FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting benefit verifications, prior authorizations, and managing patient data within a healthcare setting. Proficient in communication and coordination with healthcare professionals and insurance payers to ensure compliance and quality service delivery.
Highest-signal resume keywords
Benefit VerificationPrior Authorization SubmissionPatient Data ManagementCommunication SkillsThird Party Billing Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance Claims ProcessingMedical TerminologyData EntryAnalytical SkillsDetail Orientation
Soft Skills
Time ManagementCustomer Service
Tools & Technologies
MS Office ApplicationsDatabase Management
Certifications & Qualifications
High School Diploma/GED
Industry Keywords
Pharmacy Benefit ManagerMedical ManagementREMS RequirementsBiotechnologyPharmaceutical
About the role
Key responsibilities & impact- Conduct outbound calls to insurance payers to complete Pharmacy Benefit Manager (PBM) and Medical Management (MM) benefit verifications
- Conduct benefit investigations and verify insurance benefits for patients and physicians’ offices
- Submit and obtain prior authorizations as required by payers
- Obtain recertification for cases requiring extended treatment or coverage
- Accurately enter and maintain data in the client database and patient files
- Monitor outstanding items on client case files and ensure files are complete
- Participate in conference calls with Client Sales Representatives, client management, and physicians’ offices regarding case status, drug orders, and alternative funding
- Coordinate product orders, shipments, and therapy initiation with pharmacies and patients
- Participate in call center activities, including triaging and responding to incoming calls
- Serve as a single point of contact for an assigned group of prescribers, as needed
- Identify and report events in accordance with REMS requirements
- Recognize adverse events, product quality complaints, and potential risk events and forward information for manufacturer reporting
- Educate patients, prescribers, and others regarding program requirements and facilitate referrals
- Maintain quality and production standards and comply with company, state, and federal safety and environmental procedures
Requirements
What you’ll need- High School Diploma/GED or equivalent experience
- 4–6 years’ experience in the insurance, biotechnology, or pharmaceutical industries; customer service and/or reimbursement
- Health Insurance claims or patient accounting experience a plus
- Computer proficiency in MS Office applications, with database experience a plus
- Excellent written and verbal communication skills, with demonstrated ability to communicate with others at all levels
- Ability to manage multiple priorities and meet deadlines
- Detail oriented with good analytical skills
- Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals preferred
- HIPAA-compliant workspace
- Reliable high-speed internet
- Availability Monday through Friday, 9:00 AM–6:00 PM EST, with no flexibility in the shift
Benefits
Comp & perks- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match*
- Tuition reimbursement
- Flexible work environment
- 20 days PTO
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine (Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short and long term disability
- Life insurance
- Discount programs
- UBC will provide all required equipment, including desktop hardware and software