Pharmacy Claims Representative

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

📋 Description

• Review, analyze, and accurately process pharmacy claims while ensuring timeliness and compliance with both company and regulatory standards in a remote call center setting.

• Identify discrepancies, investigate claim-related issues, and determine suitable resolutions.

• Engage with pharmacies, providers, and internal teams to clarify information and rectify errors.

• Assist with audits and quality assessments by maintaining comprehensive and precise claim documentation.

• Recognize trends and provide insights that can enhance claim accuracy and operational efficiency.

• Maintain confidentiality and adhere to HIPAA and corporate policy standards.

⛳️ 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 platforms and Microsoft Office applications.

• Ability to communicate professionally with providers and team members.

• Exceptional attention to detail with a commitment to accuracy on the first attempt.

• High School diploma or equivalent required.

• Experience in pharmacy claims adjudication.

• Background in a pharmacy environment.

• Proficient in Microsoft Office Suite.

• Clear and effective communication skills.

• CPhT or EXCPT certification preferred.

• Associate's degree or higher preferred.

🏝️ Benefits

• Competitive Pay starting at $22.00 per hour.

• 12% shift differential applied to all hours worked after 6:00 PM on weekdays.

• 5% shift differential applied to all weekend hours worked.

• Comprehensive Benefits Package (Health, Dental, Vision, PTO, Sick Time, 401k with match, etc.).

• Opportunities for Growth and Career Advancement.

• Agile and Adaptable team culture.

• Innovative and revolutionary technology solutions.

• Continuous learning and skill development.

• Career advancement opportunities.