Pharmacy Claims Representative

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

📋 Description

• Accurately and promptly review, analyze, and process pharmacy claims in a remote call center setting.

• Detect discrepancies and investigate issues related to claims.

• Determine suitable resolutions for claims.

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

• Support audits and quality assessments by maintaining thorough and precise claim documentation.

• Identify trends and share insights to enhance claim accuracy and efficiency.

• Maintain confidentiality and comply with HIPAA and corporate policy standards.

⛳️ Requirements

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

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

• Familiarity with pharmacy claims adjudication.

• Experience in a pharmacy setting.

• Working knowledge of pharmacy billing processes, insurance verification, and third-party payer systems.

• Strong analytical, organizational, and data entry skills.

• Proficiency in claims processing platforms and Microsoft Office applications.

• Ability to communicate professionally with providers and team members.

• Exceptional attention to detail.

• A high school diploma or higher is required.

• CPhT or EXCPT certification is preferred.

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

• Knowledge of HIPAA and corporate policy standards.

• Familiarity with the Microsoft Office Suite.

🏝️ Benefits

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

• Competitive salary with shift differentials for eligible evening and weekend shifts.

• Opportunities for growth and career advancement.

• Continuous learning and skill enhancement.

• A dynamic and adaptable team culture.

• Access to innovative technology solutions.

• Commitment to quality patient care.