Benefits Verification Specialist jobs in United States
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TEKsystems · 1 day ago

Benefits Verification Specialist

TEKsystems is a leading provider of business and technology services, and they are seeking a Benefits Verification Specialist. This role involves conducting high-volume outbound calls to payors and pharmacy benefit managers to determine copay support eligibility for commercially insured patients, emphasizing accurate documentation and professional customer service.

Information Technology
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H1B Sponsor Likelynote

Responsibilities

Make outbound PBM/payor calls for copay eligibility throughout the workday; maintain phone engagement up to 95% of the shift while executing the correct outbound campaigns and dispositions
Follow approved Call Guides to ask structured, plan‑identifying questions of PBM agents; use compliant script/verbiage and payor‑call steps
Determine and record the verified plan type: Traditional, Accumulator, Hybrid Accumulator, Maximizer, or Hybrid Maximizer, etc. using program definitions and SOPs
Use PBM‑specific prompts (e.g., BIN/PCN/Group workflows, NPI handling, maximizer screening questions) to obtain the benefit details needed for eligibility determination
Document every interaction accurately and in real time: complete call‑guide fields, outcomes, and notes in the designated CRM/telephony tools before taking/making the next call
Create and manage follow‑up activities/tasks as needed with timely completion
Maintain availability/status discipline in the telephony platform (Available/Ready, appropriate Away Codes, correct outbound campaign selection) to maximize connect time
Adhere to program compliance and quality standards (privacy, script adherence, recorded‑call protocols) and participate in QA monitoring
Collaborate professionally with payor/PBM contacts and internal teams; route inquiries outside program scope through approved channels
Demonstrate courtesy, respect, empathy, and a service‑first mindset on every payor/PBM interaction
Apply active listening and de‑escalation techniques with agents as needed
Uphold workplace conduct guidelines and use only approved systems/channels for communications and documentation
Phone time/adherence (targeting up to 95% outbound activity)
Call‑guide adherence and QA scores; correct plan‑type identification per program definitions
Documentation completeness and timeliness; follow‑up task creation and completion rate

Qualification

PBM knowledgeCRM proficiencyCall handlingDocumentation skillsCustomer serviceDe-escalation techniquesActive listening

Required

High-volume outbound calling experience
Ability to maintain phone engagement up to 95% of the shift
Experience using approved call guides and compliant scripts
Ability to determine and record verified plan types
Experience using PBM-specific prompts for eligibility determination
Accurate and real-time documentation of interactions
Ability to create and manage follow-up activities/tasks
Discipline in maintaining availability/status in telephony platform
Adherence to program compliance and quality standards
Professional collaboration with payor/PBM contacts and internal teams
Demonstrated courtesy, respect, empathy, and service-first mindset
Active listening and de-escalation techniques
Upholding workplace conduct guidelines
Ability to work remotely in a phone-based role
Availability to work during business hours from 8am to 8pm EST
Ability to work overtime or support campaigns during peak periods

Benefits

Medical, dental & vision
Critical Illness, Accident, and Hospital
401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
Life Insurance (Voluntary Life & AD&D for the employee and dependents)
Short and long-term disability
Health Spending Account (HSA)
Transportation benefits
Employee Assistance Program
Time Off/Leave (PTO, Vacation or Sick Leave)

Company

TEKsystems

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At TEKsystems, they understand people. Every year they deploy over 80,000 IT professionals at 6,000 client sites across North America,

H1B Sponsorship

TEKsystems has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (46)
2024 (52)
2023 (33)
2022 (22)
2021 (36)
2020 (53)

Funding

Current Stage
Late Stage

Leadership Team

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Ryan Skains
Vice President, TEKsystems Global Services
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Company data provided by crunchbase