Pharmacy Claims Representative

Job Summary

A company is looking for a Pharmacy Claims Representative 2 to manage pharmacy claims processing and ensure compliance with standards.

Key Responsibilities

• Review, analyze, and process pharmacy claims accurately and timely
• Identify discrepancies and resolve claim issues through effective communication
• Support audits and maintain detailed claim documentation while ensuring HIPAA compliance

Required Qualifications

• 1-2 years of pharmacy claims or healthcare operations experience
• Working knowledge of pharmacy billing procedures and third-party payer systems
• Proficiency in claims processing platforms and Microsoft Office tools
• High school diploma required; associate degree preferred
• Experience with pharmacy claims adjudication is required