Specialist, Insurance II

## About the Role The Insurance Specialist II role at AbbVie is a vital position that requires a unique blend of technical knowledge, customer service skills, and problem-solving abilities. As the primary point of contact for Healthcare Providers (HCPs) and patients, this role entails addressing complicated patient access challenges and providing accurate explanations of medical and pharmacy benefits. The successful candidate will be part of a dynamic team that is committed to delivering exceptional customer service and support.

The Insurance Specialist II will be responsible for investigating and resolving access issues, providing insurance coverage and verification details, and educating customers on the results of investigations. This role requires a deep understanding of commercial and government pharmacy and medical insurance programs, billing, and alternate funding resources. The ideal candidate will have a strong background in healthcare or reimbursement settings, with experience in a call center environment, healthcare office, or specialty pharmacy.

As a subject matter expert in insurance, prior authorizations, and customer service, the Insurance Specialist II will play a critical role in building, maintaining, and providing access to insurance intelligence. This will enable the productivity of the broader access team and ensure that HCPs and patients receive the support they need to navigate complex access challenges.

## What You Will Do - Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution - Investigate and problem-solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges, or non-preferred formulary issues - Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions - Clearly communicate and educate customers on the results of investigations - Complete benefit investigations, contact HCPs and/or patients, or potentially the filling pharmacy or payor as needed - Maintain an understanding of current business procedures, deviations, and case processing for all brands and channel sources - Document information in the appropriate system of record and formats - Accurately communicate insurance details to HCPs and patients via phone, other electronic communication methods, and fax, as per established policies and procedures - Identify potential Adverse Event situations for reporting to Pharmacovigilance, ensuring AbbVie meets FDA regulations - Support changing business priorities by being flexible in executing or overseeing completion of specific tasks to support patients, products, or services

## What We Are Looking For - High school diploma or GED equivalent required, degree preferred - 2-4 years of work experience in a healthcare or reimbursement setting - Understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, and alternate funding resources - Strong customer service skills and ability to work in a fast-paced environment - Excellent communication and problem-solving skills - Ability to learn and execute business process and system changes quickly - Strong analytical and critical thinking skills - Experience with insurance verification, prior authorizations, and benefit investigations

## Nice to Have - Experience in a call center environment, healthcare office, or specialty pharmacy - Knowledge of pharmaceutical industry trends and regulations - Familiarity with electronic health records and claims processing systems - Certification in healthcare or insurance-related field

## Benefits and Perks - Competitive salary and benefits package - Opportunity to work with a leading pharmaceutical company - Flexible remote work arrangements - Professional development and training opportunities - Access to cutting-edge technology and systems - Collaborative and dynamic work environment - Recognition and reward programs for outstanding performance

- To stand out in this role, highlight your experience in healthcare or reimbursement settings, and showcase your excellent customer service skills.

• Be prepared to provide specific examples of times when you had to problem-solve and resolve complex access issues.
• Familiarize yourself with AbbVie's products and services, and be ready to discuss how you can contribute to the company's mission.
• Make sure to emphasize your ability to work in a fast-paced environment and adapt to changing business priorities.
• Consider obtaining certification in a healthcare or insurance-related field to demonstrate your expertise and commitment to the field.
• When negotiating salary, be sure to research industry standards and highlight your relevant experience and skills.
• Be aware of the potential for long hours and high stress levels in this role, and be prepared to discuss how you manage stress and maintain a healthy work-life balance.