Claims Specialist

Job Summary

Working remotely in a full-time capacity, the Claims Specialist will manage and resolve pharmacy claims to ensure timely reimbursement for long-term care and senior living clients while enhancing patient care through effective claims management.

Key responsibilities

• Manage and identify rejected pharmacy claims to maximize payer reimbursement and ensure timely billing
• Research and resolve rejected claims by collaborating with Medicare D plans, third-party insurance companies, and state Medicaid plans
• Prepare and maintain reports and records for processing while monitoring revenue associated with billing processes

Required qualifications

• High School Diploma or GED required; Associate's or Bachelor's Degree preferred
• Customer service experience required; up to one year of related experience is desired
• Ability to retain and apply a large amount of information in a fast-paced environment
• Basic math aptitude and proficiency in Microsoft Office Suite required
• Pharmacy technician experience is preferred but not required