Remote Insurance Verification Specialist, Specialty; Michigan

Job Summary

Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. Handles inbound and outbound calls with customers, physician offices, patients or third‑party providers about the company's products or services following standard SOPs and procedures, working under direct supervision. Ensures all contacts receive efficient and courteous service.

• Respond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls.
• Resolve questions and problems submitted by customers and Pharmacy Benefit Managers (PBM) following established guidelines and standard SOPs and procedures. Utilize all available information to choose the best solution and resolve customer and PBM concerns.
• Request and load PBM and/or Major Medical insurance plans.
• Process all non‑clinical PBM rejections which may include but are not limited to rejections for plan limits, coverage terms or prior authorization.
• Assist physicians in the prior authorization process including initiation of prior authorizations.
• May be cross‑trained and/or work on Major Medical (MM) and Specialized PBM Plans.
• Verify benefits for Major Medical via online resources or over the phone. Confirm network status, review FDA guidelines, and prior authorization requirements to ensure payment of claims.
• Resolve questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilize all available information to choose best solutions and resolve customer and plan concerns.
• Facilitate the reimbursement windshields for PBM major medical claims.
• Identify and assess individual customer or patient needs and provide education on or assist with grant applications, complex funding needs, commercial copay assistance enrollment along with appropriate action to satisfy those needs.
• Provide primary support and expertise for specialized programs such as the patient assistance program or special handling.
• Manage Pharma requirements including but not limited to warm transfers, bridge/quick start, enhanced prior authorization and appeal support.
• May administer order queue such as Submission Problems or Waiting for Payment.
• Document contact interactions, record details, complaints, comments, and actions taken.

• High school diploma/GED.
• Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in healthcare, specialty pharmacy, PBM, call center setting or other related industry.
• Ability to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential manner.
• Basic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (e.g., start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information online).

• Experience with providing customer service related to adherence, complex disease states quality, After Call Work (ACW), etc.
• Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
• Intermediate level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (e.g., start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information online).

The salary below is being provided to promote pay transparency and equal employment opportunities. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please visit

We will consider employment of qualified applicants with arrest and conviction records.