Job Details:

The Benefit Investigator gathers all necessary insurance benefits information and prepares the appropriate documentation in adherence with the BioPlus 2-hour brand promise. The Benefit Investigator strives to work efficiently and accurately to provide appropriate and timely information to other departments.

Responsibilities

• Responsible for accurately completing benefit investigations with adherence to company’s 2-hour brand promise.

• Must be proficient in:

  • Pharmacy benefits

  • Major medical

  • Commercial insurance

  • Medicare Parts A, B, C and D

  • Supplemental Plans

  • Medicaid

  • VA (Veterans Affairs Benefits), DOD (Department of Defense), FEHB (Federal Employees Health Benefits)

• Responsible for a complete understanding of health insurance benefit structure including copay structure, co-insurance, deductibles, out of pocket, coordination of benefits, etc.

• Adjudicate claims through Pharmacy Benefit Managers.

• Ability to read and understand paid and rejected claims.

• Ability to be able to read Rx and select appropriate dose/units per day supply.

• Must have great customer service phone skills with the ability to use persistence and ask probing questions to obtain thorough and accurate information.

• Ability to work independently and within a team setting.

• Must display a positive attitude.

• Adapt to departmental and company procedures as necessary.

• Update sales staff and verification team with pertinent information.

• Participate and perform other duties as assigned by leadership

Competency

• Demonstrate the BioPlus C.A.R.T. values.

  • Competence

  • Accountability

  • Respect

  • Trust

• Excellent Computer Skills.

• Knowledge of medical terminology.

• Excellent communication skills.

• Ability to work cooperatively and be a liaison between departments when needed.

• Professional Image

Qualifications

• High School Diploma or Equivalent

• At least 1 year of insurance verification experience

• Specialty pharmacy experience preferred

• CPR+ experience a plus