Pharmacy Claims Representative 2

Profile

Description

The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Pharmacy Claims Representative 2 analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

The role will also involve collaboration and sourcing of Patient Assistance in conjunction with Claim Processing duties.

Must be available to work an 8 hour shift within office hours of 8am-8pm est. Shift will most likely be 11:30am - 8:00pm est.

Required Qualifications


At least 1 years of experience working in a medical, insurance or pharmacy claims environment.
High School Diploma
Less than 2 years of technical experience
Less than 5 years of data analysis & problem solving skills
Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint
Strong verbal and written communication skills, including the ability to tailor communication to audience
Strong organizational and time management skills
Ability to handle multiple tasks, meet deadlines, and follow-up timely
1 years of experience working in an environment that requires meeting production metrics.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Previous experience with pharmacy benefits management
Rx Nova or ScriptMed experience a plus
Claims experience
Knowledge/experience working with SQL (via MS SQL Server, Oracle, PL/SQL or other)
Pharmacy Tech experience


Additional Information


This role is Work at Home; however candidates must live in Glendale, AZ or within a commutable distance to the facility.
Work hours are between 11:30am-8:00pm; however work hours are subject to changed based on business needs. Rotational holiday coverage required (Will be required to work 1-2 holidays a year)
Must have a private office to protect confidential information
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M


Scheduled Weekly Hours

40

Company info

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