Fraud Investigation Officer jobs in Johnstown, PA

Looking for top notch call center agents to join a wonderful team!!

Weekly Pay

Full Benefits

Must be willing to work an 8 hours shift between 8am-6pm

Description:

Responsible for direct contact with Medical Insurance Payers and Pharmacy Benefit Managers in order to identify and document available coverage options for retail and specialty medications. Maintains high quality customer service standards in compliance with federal and state regulations and guidelines.

• Makes outbound calls to Payers and Pharmacy Benefit Manager in order to verify patient insurance coverage and identify available Medical and Pharmacy benefits
• Communicates case details to appropriate internal or external parties once benefit verification is complete
• Identify any payer coverage restrictions and potential mechanisms for quickly accessing therapy
• Ability to effectively contribute alone or in small work groups
• Effectively meets production and time completion goals
• Accurately document payer Prior Authorization and Appeals protocols
• Participate in special projects and perform additional duties as required
• Maintain repository of payer or brand specific coverage information
• Participate in training and process improvement initiatives

Additional Skills & Qualifications:

• Minimum of 1) 2 years’ experience in customer service, insurance, benefits, marketing, sales or related area, required, or 2) Bachelor’s degree and 1-year of relevant experience
• Health care environment with third party benefits verification experience preferred.
• Understanding of commercial insurance concepts including coverage policies, major medical benefits, knowledge of government and patient assistance program, knowledge of and understanding of how to communicate information on health insurance, reimbursements, third party terms and medical terminology is preferred
• Highly proficient computer skills.
• Skill in managing email correspondence and personal documentation of research.
• Focus on fundamental analytic and problem-solving skills.
• Excellent time management skills
• Strong professional customer services experience
• High level of attention to detail
• Be a critical thinker who is adaptable, and results driven.

Experience Level:

Expert Level

About Aston Carter:

Please Note: Scammers are posing as Aston Carter. We'll never contact you via Gmail, Telegram, or WhatsApp and we'll never solicit money from you.

At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.

Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email astoncarteraccommodation@astoncarter.com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.