Benefits Investigation Specialist

Job Description

Location: Silver Spring, MD

TalentLNX is partnering with a reputable healthcare organization in Silver Spring, Maryland, to hire a compassionate and detail-oriented Benefits Investigation Specialist. This full-time, onsite position is instrumental in helping patients access essential retail and specialty medications by verifying insurance coverage and accurately documenting benefit details.

This role is ideal for professionals with experience in pharmacy benefits, medical insurance verification, or patient support services. The successful candidate will demonstrate strong communication skills, a customer-first mindset, and the ability to navigate complex payer systems with accuracy and efficiency.

Responsibilities:

• Insurance Verification: Initiate outbound calls to commercial and government insurance payers and Pharmacy Benefit Managers (PBMs) to verify coverage for prescribed medications under both pharmacy and medical benefits.
• Coverage Documentation: Accurately capture benefit details such as copay information, coverage limits, prior authorization requirements, and appeal procedures in accordance with company standards and compliance requirements.
• Access Navigation: Identify payer restrictions and propose solutions for rapid access to therapies, including patient assistance programs or alternate coverage channels.
• Case Communication: Share case findings and benefit details with internal teams and external stakeholders to facilitate patient access to prescribed therapies.
• Workflow Contribution: Demonstrate the ability to contribute effectively in both independent and small team environments, maintaining consistent communication and service standards.
• Compliance & Quality: Adhere to all applicable federal and state regulations and internal quality standards when conducting benefit investigations and documentation.
• Special Projects: Participate in department-wide process improvement initiatives, special projects, and ongoing training to enhance professional development and overall service efficiency.
• Knowledge Repository: Support the development and maintenance of an internal database of payer-specific or brand-specific coverage requirements and access trends.

Work Environment:

The Benefits Investigation Specialist will operate within a professional office setting that emphasizes collaboration, compassion, and accuracy. The organization fosters a culture of teamwork, service excellence, and continuous growth, providing team members with the opportunity to make a direct impact on patient access to care.

Qualifications:

• Education: High school diploma or equivalent is required; a Bachelor’s degree is preferred.
• Experience: Minimum of 2 years of experience in customer service, healthcare benefits, insurance, or pharmacy-related roles—or 1 year of relevant experience with a Bachelor’s degree.
• Knowledge: Familiarity with commercial insurance plans, major medical benefits, PBM operations, and government or patient assistance programs.
• Skills: Strong communication and documentation skills, proficiency in Microsoft Office tools, and the ability to work across multiple platforms and dual-monitor setups.
• Attributes: High attention to detail, effective time management, and a strong sense of accountability in patient-facing service environments.

Schedule 

• Full-time, onsite
• Monday – Friday, 8:00 AM – 5:00 PM
• Standard Office Environment

Salary Range: Compensation for this role ranges from $60,000 to $75,000 per year (approximately $28.00 to $36.00 per hour), depending on experience and qualifications.

Interview Process:

• Initial Screening – TalentLNX Recruiting Team
  A 20–30 minute phone conversation designed to learn more about your background and career goals. We’ll share additional details about the role, clarify expectations, and ensure this opportunity aligns with what you’re seeking in your next position—whether it’s culture, compensation, growth potential, or long-term career direction.

  Second-Round Interview – Hiring Manager (Program Lead or Operations Manager)
  A virtual interview with the direct hiring manager. This conversation will focus on your experience with benefits verification, payer communications, and documentation accuracy. You may be asked to walk through real-world examples or respond to role-based scenarios.

  Final Interview – Onsite Meeting with Key Team Members
  An in-person meeting with 1–2 members of the pharmacy services, operations, or patient access teams. Because where you work—and who you work with—matters just as much as the work you do, this step ensures mutual alignment on values, collaboration style, and team dynamics.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds, and we encourage all qualified candidates to apply for our job opportunities.