Insurance Specialist Lead

PURPOSE AND SCOPE:
Supports Insurance Specialist Manager in the strategic initiatives of the Insurance Coordination Program as the subject matter experts of the premium assistance options for ESRD patients. This includes providing coverage support in coordinating patient grant requests for the American Kidney Fund's Health Insurance Premium Program (HIPP) according to program guidelines while maintaining a high regard for all compliance, regulatory, and company policies. Supports FME’s mission, vision, core values and customer service philosophy.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Under general supervision, established company policies and procedures follow established and applies acquired job skills in performing duties as follows.
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Takes lead responsibility for distribution and creation of AKF reports, including but not limited to: HIPP Payment, Returned Tickets, and daily team reports.
• Provides PTO and temporary vacancy coverage for IS team responsibilities and overflow grant management support as needed to ensure continuity of patient care.
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Manage AKF SharePoint Site changes, including all requested updates to Clinic Database by IC Supervisors/Managers.
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Manages internal team access to GMS.
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Ensures accuracy of clinics in GMS database; requests the addition of new clinics and the correction of addresses as needed
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Assist IS Manager with outreach to AKF via GMS when requested/as needed
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Partner with IS Manager to address IC training/retraining needs as requested by IC Supervisors/Managers; evaluate the effectiveness of current training materials and make recommendations for improvements based around GMS Guidelines and FME Compliance
• Collaborate with IS Manager to support training, shadowing, and clinic rollout activities for new hires as needed
• Provide structured mentoring and reinforcement of core IS competencies to ensure new hires successfully transition into their role
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Manages assigned caseload for timely grant submission
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Represents IS team as SME, assists IS Manager with fielding grant and calculation questions from IC Supervisors
• Evaluate the effectiveness of vacancy coverage through assigned metrics and feedback; recommend workflow or process improvements.
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Other duties as assigned.
Additional responsibilities may include focusing on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
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The physical demands and work environmental characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
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Day-to-day work includes desk and personal computer work and interaction with patients, facility staff and physicians.
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Minimal travel may be required.
SUPERVISION:
2
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None
EDUCATION:
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High school diploma required. Some college preferred.
EXPERIENCE AND REQUIRED SKILLS:
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At least 3-5 years of experience in an Insurance Specialist role with proven ability to manage complex caseloads.
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Demonstrated ability to engage, motivate, and develop others, strong understanding of the impact and complexity of the Insurance Specialist role.
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Proven training, facilitation, and adult-learning competencies with experience delivering both in-person and virtual training.
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Excellent verbal, written, and presentation skills with the ability to communicate complex information clearly and confidently.
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Strong problem-solving skills with the ability to analyze issues and develop practical, scalable solutions.
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Demonstrated strength in team collaboration, coaching, and task management.
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Strong collaborative abilities with a clear understanding of the Insurance Specialist role’s impact and a commitment to supporting a large territory remotely.
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Demonstrated success working independently in a remote environment, with the ability to adapt, troubleshoot, and remain productive despite common remote-work challenges.
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Strong collaborative abilities both within the team and with the IC Program
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Exceptional interpersonal and motivational skills, with the ability to build trust and strong working relationships across Insurance Coordinator teams.
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Excellent verbal and written communication skills, including effective email, phone, and virtual communication.
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Strong problem-solving and critical-thinking abilities, with a demonstrated ability to solve complex mathematical problems; ability to clearly explain resolution in writing.
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Ability to effectively prioritize, multitask, and manage time in a fast-paced, remote environment; strong attention to detail and follow-through.
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Results-driven mindset with a commitment to quality, accuracy, and continuous improvement.
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Proficiency in Microsoft Office applications (Excel, Word, PowerPoint) and strong general computer literacy.