Verification Specialist

Position: Benefits Verification Specialist
Description

Role Summary

Care Managers conduct high‑volume outbound calls to payors/pharmacy benefit managers (PBMs) to determine whether commercially insured patients on supported products are eligible for copay support. This role is phone‑intensive (up to 95% of the shift on calls), requires disciplined use of approved call guides, precise documentation in our systems, and professional customer service on recorded lines. There is no patient or caregiver interaction in this role.

Essential Duties & Responsibilities

- Make outbound PBM/payor calls for copay eligibility throughout the workday; maintain phone engagement up to 95% of the shift while executing the correct outbound campaigns and dispositions.

- Follow approved Call Guides to ask structured, plan‑identifying questions of PBM agents; use compliant script/verbiage and payor‑call steps.

- Determine and record the verified plan type:
Traditional, Accumulator, Hybrid Accumulator, Maximizer, or Hybrid Maximizer, etc. using program definitions and SOPs.

- Use PBM‑specific prompts (e.g., BIN/PCN/Group workflows, NPI handling, maximizer screening questions) to obtain the benefit details needed for eligibility determination.

- Document every interaction accurately and in real time: complete call‑guide fields, outcomes, and notes in the designated CRM/telephony tools before taking/making the next call.

- Create and manage follow‑up activities/tasks as needed with timely completion.

- Maintain availability/status discipline in the telephony platform (Available/Ready, appropriate Away Codes, correct outbound campaign selection) to maximize connect time.

- Adhere to program compliance and quality standards (privacy, script adherence, recorded‑call protocols) and participate in QA monitoring.

- Collaborate professionally with payor/PBM contacts and internal teams; route inquiries outside program scope through approved channels.

Customer Service & Conduct

- Demonstrate courtesy, respect, empathy, and a service‑first mindset on every payor/PBM interaction.

- Apply active listening and de‑escalation techniques with agents as needed.

- Uphold workplace conduct guidelines and use only approved systems/channels for communications and documentation.

Performance Metrics (Examples)

- Phone time/adherence (targeting up to 95% outbound activity).

- Call‑guide adherence and QA scores; correct plan‑type identification per program definitions.

- Documentation completeness and timeliness; follow‑up task creation and completion rate.

Work Conditions & Schedule

This is a remote phone‑based, payor/PBM‑facing role conducted on recorded lines. Copay Business hours are 8am to 8pm EST. However, candidates in this role may be assigned Standard business hours with shift assignments; overtime or campaign support may be requested during peak periods.

Job Type & Location

This is a Contract position based out of Raleigh, NC.

Pay and Benefits

The pay range for this position is $21.00 - $21.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

- Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Final date to receive applications

This position is anticipated to close on Jan 23, 2026.

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