Pharmacy Claims Representative

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Accurately and promptly review, analyze, and process pharmacy claims.

• Comply with company policies and regulatory requirements.

• Detect discrepancies and conduct investigations on claim issues.

• Establish suitable resolutions for claims.

• Liaise with pharmacies, providers, and internal teams to clarify details and rectify errors.

• Assist with audits and quality assessments.

• Keep thorough and accurate documentation of claims.

• Recognize trends and provide insights to enhance claim accuracy and efficiency.

• Maintain confidentiality and ensure HIPAA compliance.

• Operate within a remote call center setting.

⛳️ Requirements

• 1–2 years of experience in pharmacy claims or healthcare operations.

• Familiarity with pharmacy billing processes, insurance verification, and third-party payer systems.

• Strong analytical, organizational, and data entry capabilities.

• Proficient in claims processing systems and Microsoft Office applications.

• Ability to communicate professionally with providers and team members.

• Exceptional attention to detail.

• Dedication to achieving accuracy on the first attempt.

• A high school diploma or higher is required.

• At least 1 year of experience in pharmacy claims billing.

• Experience in pharmacy claims adjudication.

• Background in a pharmacy setting is advantageous.

• CPhT or EXCPT certification is preferred.

• Availability to work Monday–Friday from 2:30 PM to 11:00 PM EST, including every fourth weekend rotation.

• Compliance with HIPAA and corporate policies.

🏝️ Benefits

• Competitive starting salary of $22.00 per hour.

• Additional 12% shift differential for hours worked after 6:00 PM on weekdays.

• 5% shift differential for all weekend hours worked.

• Comprehensive benefits package that includes health, dental, vision, PTO, sick leave, and a 401(k) plan with a matching contribution.

• Opportunities for growth and career progression.

• Continuous learning and skill enhancement.

• Access to innovative and cutting-edge technology solutions.

• A flexible and responsive team culture.