Case Manager

Case Manager

Case Managers serve as subject matter experts responsible for resolving complex patient, provider, pharmacy, and client support issues that fall outside standard program workflows and business rules. This role provides both inbound and outbound phone support for escalated cases identified by Care Managers, clients, leadership, and stakeholders. The Case Manager investigates issues, coordinates cross-functional resolutions, educates stakeholders, and ensures an exceptional service experience through proactive case ownership and timely resolution of complex support requests. This is a remote position.

The information contained herein is intended to be an accurate reflection of the duties and responsibilities of the individuals assigned to this position. They are not intended to be an exhaustive list of the skills and abilities required to do the job. IQVIA reserves the right to revise the job or to require that other or different tasks be performed as assigned.

Responsibilities

Client Support

·Serve as a dedicated resource for clients requiring advanced case support and issue resolution.

·Manage referrals involving complex reimbursement, claims, affordability, benefit verification, and patient access concerns.

·Provide inbound and outbound communication with clients, healthcare providers, pharmacies, patients, and stakeholders to facilitate resolution.

·Partner with clients, and internal operational partners to address high-priority or time-sensitive patient situations.

·Deliver white-glove service and proactive follow-up for complex cases requiring enhanced oversight and coordination.

Additional Key Responsibilities

• Handle escalations involving repeat callers, claim disputes, exception requests, client-approved overrides, and situations requiring enhanced case ownership.
• Review and resolve support requests received through the Escalation Tool, HUB Portal requests, referrals, inbound calls, emails, and internally generated escalations.
• Maintain ownership of assigned cases through resolution, ensuring all actions, root causes, and outcomes are appropriately documented.
• Responsible for answering in-bound and making outbound calls and assisting customers with pharmacy-related services.
• Obtain client information by answering telephone calls; interviewing clients; verifying information.
• Contact insurance companies for benefit investigation and coverage eligibility.
• Provide customers with courteous, friendly, fast, and efficient service.
• Update job knowledge by participating in educational opportunities and training activities.
• Work efficiently both individually and within a team to accomplish required tasks.
• Maintain and improve quality results by adhering to standards and guidelines and recommending improved procedures.
• Any additional duties as assigned by program management.

Schedule

• Must be available to work an 8-hour shift between 8:00 AM and 8:00 PM EST

Required Qualifications:

• High School diploma required or equivalent.
• Must currently be working on an AbbVie project
• Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines.
• Demonstrated effective presentation skills
• Excellent interpersonal (written and verbal) communication skills.
• Demonstrated effectiveness to work cross-functionally within a team.
• Demonstrated ability to work effectively in an independent environment.
• Demonstrated ability to build relationships with customers and third parties.
• Demonstrated ability to adapt to a fast-paced, changing work environment and responsibilities.
• Fully competent in MS Office (Word, Excel, PowerPoint)
• Excellent documentation accuracy
• Drive and enthusiasm for supporting customers.
• Excellent listening and problem-solving skills
• Previous data entry experience and ability to type 30wpm+
• Ability to use MS Office
• Must reside in country where the job is posted.

Preferred Qualifications:

• Associate degree or higher preferred.
• Minimum 2+ years' experience in medical billing, insurance verification, or similar patient services experience preferred.
• Experience using a CRM and integrated telephony platform a plus.
• Bilingual (Spanish) highly desirable

Note: This role is not eligible for visa sponsorship. Candidates must have authorization to work in the US without the need for sponsorship.