Phil, Inc.

Customer Support

• Place outbound calls to insurance carriers and navigate payer phone systems to reach eligibility and benefits representatives
• Verify active coverage and obtain detailed benefits information including deductibles, copays, coinsurance, out-of-pocket maximums, prior authorization requirements, and in/out-of-network benefit levels
• Accurately document all information obtained during each call, including reference numbers, representative names, and call timestamps
• Interpret call outcomes and apply decision criteria to move each case to the correct next step in the workflow (e.g., eligible for services, requires prior auth, inactive/terminated coverage, patient financial responsibility assessment, denial routing)
• Identify discrepancies between payer-reported benefits and information on file and escalate appropriately
• Meet daily productivity and quality standards for call volume and documentation accuracy
• Maintain working knowledge of common insurance terminology, plan types (HMO, PPO, EPO, HDHP), and payer-specific requirements

Benefits Support Specialist

AI Engineer

• Assist in the design, development, testing, and deployment of AI/ML models and applications
• Collaborate with Engineering, IT, and business stakeholders to translate business needs into technical solutions
• Build and optimize data pipelines and inference workflows
• Develop prototypes and AI-powered applications within cloud environments such as AWS
• Work with both structured and unstructured datasets, including text, APIs, and image-based data
• Experiment with large language models (LLMs), prompt engineering techniques, and AI APIs
• Document code, experiments, and technical findings for team collaboration and knowledge sharing
• Participate in code reviews, sprint planning, and technical discussions with the Engineering team
• Present project work and findings to technical and business stakeholders
• Support additional projects and initiatives as needed across the department

AI Engineering Intern

Pharmacist

• Conduct thorough research on order and ticket history to recommend the best resolution that aligns with department guidelines.
• Ensure all Service Level Agreements (SLAs) are met.
• Contact relevant stakeholders to resolve issues that require cross functional collaboration that may impact a successful patient experience.
• Build strong internal and external rapport, maintaining positive customer and partner relationships.
• Review and respond to internal escalation requests in a timely and accurate manner.
• Proactively initiate, troubleshoot, and resolve PAs and appeals via vendor portals; analyze determination trends to provide valuable insights for patient education.
• Serve as the expert liaison between prescribers, insurance payers, and partner pharmacies, translating technical hurdles into actionable solutions that ensure patient access to therapy.
• Partner closely with Customer Support to provide clear, jargon-free updates and documentation in our operating systems, ensuring the team has the patient-ready insights needed to support the patient’s journey.
• Efficiently navigate multiple software systems and vendor portals with a self-starter mindset, maintaining the flexibility to prioritize tasks based on clinical urgency.
• Investigates complex claim rejections and partners with payers and pharmacies to diagnose root causes and establish and execute a clear resolution pathway that is in accordance with regulatory requirements and manufacturer business rules.
• Act as the primary technical "fixer" for orders falling outside standard workflows, resolving obstacles such as insurance exceptions, pharmacy rejections, failed transfers, and state-specific shipping regulations.

Patient Support Pharmacy Solutions Coordinator

• Troubleshooting electronic, faxed, and verbal prescriptions via routing to appropriate channels into pharmacy systems
• Review and update patient insurance using payer portals and phone resources
• Determining appropriate situations for a prior authorization (PAs) need via payer-specific tools; troubleshoot denials and escalations
• Utilize reroute best practices for orders falling outside normal workflow, including orders with state changes, insurance exceptions, pharmacy rejections, or failed transfers
• Navigate operational platforms (e.g., BestRx, Ops Dash, Partner Dash, RelayHealth, etc.) and vendor systems effectively
• Follow reroute protocols for specific tags including: non-contracted pharmacies, state shipping changes, PP send-backs, transfer not received, and more
• Proactively document process notes with clear routing details, claim updates, and actions taken
• Communicate with partner pharmacies, provider offices, and insurance carriers to resolve issues or clarify documentation
• Collaborate with At-Risk, Partner Management, and PPM teams to escalate or flag orders based on system outages, stock issues, or policy refusals
• Maintain productivity in the Reroute queue even during extended call hold times (e.g., multitask during insurance calls)
• Ensure all patient, prescriber, and partner communications are clear, professional, and aligned with Phil’s standards of care

Pharmacy Technician – Prescription Routing, Claims Support

Manager

• Serve as the primary point of contact for high-priority sales and client escalations, ensuring timely, high-quality resolution in line with SLAs
• Partner closely with Client Success team to drive confidence and enable account growth through responsive, solution-oriented escalation management
• Coordinate cross-functional efforts across Operations, Pharmacy Support, and other internal teams to resolve complex prescription and access issues
• Identify root causes of recurring escalations and partner with internal teams to drive process improvements and reduce future volume of escalations
• Maintain clear and proactive communication with stakeholders, including internal teams, prescribers, and payer/pharmacy partners as needed
• Support the evolution of escalation workflows, documentation, and tooling to improve efficiency and scalability as the business grows
• Contribute to staffing and operational planning by identifying trends in escalation volume, particularly during key growth moments (e.g., new client launches, salesforce expansion)
• Leverage expertise in pharmacy processing to accurately diagnose claim rejections (e.g., plan benefit exclusions, prior authorization requirements, or network restrictions) and identify whether the resolution requires intervention from the insurance payer, provider office, or partner pharmacy

Benefits Support Specialist

AI Engineering Intern

Patient Support Pharmacy Solutions Coordinator

Pharmacy Technician – Prescription Routing, Claims Support

Client Escalations Manager/Specialist