Job Description

From Intake to Outcomes, CAREMETX is dedicated to supporting the patient journey by providing hub services, innovative technology, and decision-making data to pharmaceutical, biotechnology, and medical device innovators.

JOB TITLE: LEAD BENEFIT VERIFICATION SPECIALIST

POSITION SUMMARY:

Under the general direction of the Micro-Hub Leadership, the Lead Benefit Verification Specialist is responsible for the day-to-day tactical support and coaching activities of remote staff performing Benefit Verifications for a designed team within a Micro-Hub. The Team Lead will assist the Supervisor and Area Director or Area Manager in meeting the team’s daily and weekly productivity goals, achieving customer service expectations, and ensuring quality control measures are followed for all assigned projects.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Provides day-to-day instructions to team members on processing Benefit Investigations.
• Provides coaching and issue resolution support to assigned team members as it relates to the successful completion of a benefit investigation.
• Monitors seasonal employee task-specific job performance to ensure that specific necessary tasks are completed in accordance with client service level requirements for processing a benefit investigation.
• Conducts daily monitoring of employee production to ensure teams meet or exceed performance standards and achieve quality control measures
• Assist the Supervisor and Area Director/Manager with various training initiatives necessary to prepare the Reimbursement Specialist, Seasonal to meet all performance benchmarks required to process benefit verifications.
• Escalates issues as appropriate to the Supervisor under prescribed protocols
• Assist with the development of program training documents.
• Ensures open communication with the staff.
• Proactively identifies program issues and proposes ways in which to address these challenges to their Supervisor
• Maintains positive rapport with internal and external customers.
• Performs related duties as assigned, including benefit verifications.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• Previous 2+ years of experience in a specialty pharmacy, medical insurance, reimbursement hub, physician’s office, healthcare setting, and/or insurance background preferred.
• Prior experience in processing benefit investigations in a fast-paced dynamic environment is highly desirable.
• Bachelor’s Degree Preferred, but not required.
• Previous supervisory or leadership experience is preferred, but not required
• Experience in directing a remote workforce is highly desirable

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

• Strong interpersonal skills and attention to detail.
• Ability to communicate effectively both orally and in writing.
• Ability to grasp and apply supervisory and coaching concepts and best practices
• Ability to learn new computer systems and apply in a fast-paced setting
• The ability to manage multiple tasks and meet deadlines.
• Working knowledge of Microsoft Office.
• Ability to resolve associate issues effectively and efficiently.
• Proven ability to appropriately escalate issues to management.
• Provides a climate for motivation and support.
• Ability to appropriately delegate task.
• Ability to work remotely.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

SCHEDULE

Must be flexible on schedule and hours

May be required to work weekends as work volume dictates

May be required to complete on-line training programs at off-work hours Some travel may be required

CAREMETX considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CAREMETX we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CAREMETX is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Company Description

Every day, CareMetx makes a difference in the lives of people facing complex health challenges. CareMetx is a specialty hub services and technology company providing patient-centric services supported by state-of-the-art proprietary technology. Bio-pharmaceutical and device manufacturers who have developed life-changing niche products, come to us to provide expert reimbursement support and clinical services for patients who have been prescribed these innovative products. Aside from having an experienced, compassionate work force, dedicated to the highest quality patient care, CareMetx delivers mobile solutions, dashboards, portals and other technology solutions to help track and manage the patient's journey "from intake to outcomes."​ CareMetx'​ portfolio includes "human services"​ such as reimbursement case management, clinical care coordination, patient assistance program management; and cutting edge technology services such as data aggregation, analysis and reporting solutions that may be "bolted on"​ to existing HUB technology for greater data access. Our mobile data collection and reporting tools for use by manufacturers, providers and patients support and sustain patient access to complex therapies. CareMetx is a privately-held, high-achieving, patient-focused company powered by 21st century technology solutions.