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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in patient case management, including benefit investigations, prior authorizations, and effective communication with patients and healthcare providers. Proficient in utilizing electronic tools for coverage determination and managing inquiries while adhering to corporate policies and procedures.
Highest-signal resume keywords
Patient Case ManagementBenefit InvestigationsPrior AuthorizationsClear CommunicationBilingual Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Benefit InvestigationsPrior AuthorizationsCase ManagementFinancial Qualifications AssessmentTyping (35 WPM, 97% Accuracy)Electronic Tools UtilizationDocumentation in PharmaCord LynkAdherence Services CoordinationProgram Rules ManagementMedical Inquiry Reporting
Soft Skills
Customer ServiceDetail OrientedProfessional Telephone EtiquetteMultitaskingRelationship Building
Tools & Technologies
PharmaCord LynkLynk Technology
Industry Keywords
Healthcare IndustryPatient Assistance ProgramsSOPsCorporate PoliciesRemote Work Eligibility
About the role
Key responsibilities & impact- Own patient cases from initiation to closure
- Perform benefit investigations and prior authorizations/denial appeals
- Determine financial qualifications for assistance programs
- Assist patients and callers/stakeholders through resolution via email, inbound/outbound calls, and Lynk technology
- Build trusted relationships with patients, prescribers, and client stakeholders
- Perform program welcome calls and post-benefits-investigation calls
- Explain coverage options to patients and physicians
- Manage client and HCP inquiries according to program rules
- Manage inbound calls and triage patients to appropriate resources
- Provide personalized case management and communicate benefit coverage and next steps
- Identify benefits and payer coverage using electronic tools and manual investigations
- Communicate prior authorization, appeal, tier exception, and formulary exclusion requirements
- Follow up with payers and HCPs on submissions and outcomes
- Coordinate nurse education, nurse follow-up, adherence services, and peer support resources
- Coordinate product shipments through patient assistance and bridge programs
- Manage prior authorization reverification and patient assistance re-enrollment needs
- Report adverse events, product complaints, special situation reports, and medical inquiries
- Document activities in the PharmaCord Lynk system
- Follow SOPs, business rules, corporate policies, and training deadlines
- Perform additional assigned tasks or projects
Requirements
What you’ll need- Bachelor’s degree strongly preferred or equivalent experience required
- Customer service and healthcare industry experience preferred but not required
- Ability to work an 8.5-hour shift between 8 am and 9 pm, Monday to Friday
- Basic computer knowledge
- Ability to multitask effectively
- Clear and concise communication
- Professional telephone etiquette
- Detail oriented
- Must meet all work-from-home criteria; remote eligibility based on business need
- Ability to type at least 35 words per minute with 97% accuracy preferred
- Flexibility to travel as needed preferred
- Successful completion of a background check and, depending on the position, a drug screen
- Spanish and English bilingual skills are a plus
Benefits
Comp & perks- Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
- Telehealth and Employee Assistance Program (EAP) services
- Company match on Health Savings Account contributions
- Free Basic Life and AD&D coverage equal to annual earnings, with a minimum of $50,000 and a maximum of $300,000
- Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
- 401(k) Retirement Savings Plan with 100% match on the first 5% contributed, with immediate vesting
- Paid Time Off (PTO) and Sick Leave
- Nine paid holidays plus two floating holidays
- Opportunities for advancement and personal and professional growth
- Challenging, stimulating work environment encouraging new ideas
- Inclusive workplace and mission-driven culture
- Minimal travel flexibility preferred