Benefit Investigation Specialist

Job Title: Benefit Investigation Specialist
Location: Pittsburgh, PA 15275
Duration: 5 Months+ (With Possibility of extension)

Shift Options:

• Monday to Friday, 8:00 AM – 4:30 PM
• Monday to Friday, 8:30 AM – 5:00 PM

 
Position Overview:
The Benefit Investigation Specialist is responsible for contacting medical insurance payers and pharmacy benefit managers to verify and document coverage for retail and specialty medications. This role is essential in supporting patient access to therapy by identifying payer restrictions and options for overcoming access barriers.
 
Key Responsibilities:

• Conduct outbound calls to payers and PBMs to verify patient insurance coverage (Medical & Pharmacy).
• Communicate benefit details and case statuses to internal/external stakeholders.
• Identify restrictions and access pathways (e.g., prior authorization, appeals).
• Accurately document payer policies, including prior authorization and appeals processes.
• Meet production metrics and completion deadlines.
• Maintain a repository of payer and brand-specific information.
• Participate in process improvement initiatives and training programs.
• Work both independently and in team settings to support department goals.

 
Required Skills & Experience:

• Experience:
  • 2+ years in customer service, insurance, benefits, marketing, sales, or related field OR
  • Bachelor’s degree with 1+ year relevant experience.
  • Preferred: Experience in healthcare environment with third-party benefits verification.
• Knowledge/Skills:
  • Strong understanding of insurance concepts: coverage policies, major medical benefits, government/patient assistance programs.
  • Medical terminology knowledge preferred.
  • Excellent written and verbal communication skills.
  • Strong documentation and note-taking abilities.
  • Proficiency in Microsoft Office, especially Excel.
  • Strong organizational, time management, and critical thinking skills.
  • Customer service-oriented with a high attention to detail.
  • Results-driven, adaptable, and collaborative.