Claims Operations Specialist

Job Summary

A company is looking for a Claims Operations Analyst responsible for managing benefit and claims issues and ensuring operational efficiency.

Key Responsibilities:

• Investigate and resolve complex claim, eligibility, and accumulator issues within service level agreements
• Conduct root cause analysis to identify fixes and improvements to claims processes
• Monitor claims data to identify trends and coordinate with relevant departments for effective claims processing

Required Qualifications & Experience:

• 1-2 years of experience in pharmacy benefit administration or related areas
• Bachelor's degree or equivalent experience
• Experience in issue management and problem resolution
• Strong analytical skills with the ability to interpret data and identify trends
• Prior experience with claims adjudication platforms and direct reimbursement processes