Pharmacy Claims Representative

Job Summary

Pharmacy Claims Representative, this full-time position in a remote call center involves reviewing, analyzing, and processing pharmacy claims while ensuring accuracy and compliance with regulations.

Key Responsibilities

• Review, analyze, and process pharmacy claims accurately and timely
• Identify discrepancies and resolve claim issues through effective communication
• Maintain detailed documentation and support audits and quality reviews

Required Qualifications, Training, and Education

• 1-2 years of pharmacy claims or healthcare operations experience
• Working knowledge of pharmacy billing procedures and insurance verification
• Proficiency in claims processing platforms and Microsoft Office tools
• High school diploma required; associate degree preferred
• Experience with pharmacy claims adjudication and in a pharmacy environment