Insurance Specialist II

Location: Onsite in North Chicago, Illinois, United States

Salary: $27–$48.80 per hour

Company

hirify.global develops medicines and healthcare solutions across therapeutic areas including immunology, oncology, neuroscience, and aesthetics.

What you will do

• Serve as a subject matter expert and primary contact for healthcare providers and patients facing insurance and patient-access challenges.
• Provide coverage verification, prior authorization and appeal guidance, formulary information, and alternate funding options.
• Investigate escalated cases involving complex access, copay or savings card issues, non-preferred formularies, and pharmacy or payer coordination.
• Document investigations accurately and communicate insurance and access information by phone, electronic communication, and fax.
• Identify potential adverse events for Pharmacovigilance reporting and comply with FDA requirements.
• Support process improvements, training, coaching, and cross-functional Patient Support Service activities.

Requirements

• High school diploma or GED equivalent required; degree preferred.
• 2–4 years of experience in healthcare or reimbursement, preferably in a call center, healthcare office, or specialty pharmacy.
• Knowledge of commercial and government medical and pharmacy insurance, billing, reimbursement, prior authorizations, appeals, and specialty pharmacy operations.
• Experience with Medicare Part D, Medicaid, alternate funding resources, private payers, pharmacy benefits, and medical benefits is preferred.
• Strong written and verbal communication, organization, problem-solving, accuracy, and ability to manage multiple priorities.
• Proficiency with Microsoft Office and ability to learn and navigate other computer systems.

Culture & Benefits

• Paid time off, including vacation, holidays, and sick leave.
• Medical, dental, and vision insurance for eligible employees.
• 401(k) plan for eligible employees.
• Eligibility to participate in short-term incentive programs.
• Work environment governed by privacy, legal, compliance, and patient-support standards.