Pharmacy Claims Representative

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

📋 Description

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

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

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

• Assist in audits and quality assessments by keeping detailed and accurate documentation of claims.

• Detect trends and share insights aimed at enhancing 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 and a commitment to accuracy on the first attempt.

• A high school diploma or equivalent is required.

• Experience in pharmacy claims adjudication.

• Background in a pharmacy environment is preferred.

• CPhT or EXCPT certification is a plus.

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

• Capable of adhering to HIPAA and corporate policy standards.

🏝️ Benefits

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

• Opportunities for growth and career advancement.

• Ongoing learning and skill enhancement.

• A flexible and adaptable team culture.

• Access to innovative and revolutionary technology solutions.

• Competitive compensation with differentials for evening and weekend shifts.