Pharmacy Claims Representative

Job Summary

Pharmacy Claims Representative, this full-time position involves reviewing, analyzing, and processing pharmacy claims in a remote call center environment, with a schedule of Monday to Friday and every fourth weekend rotation.

Key Responsibilities

• Review, analyze, and process pharmacy claims accurately and timely
• Investigate claim discrepancies and communicate with pharmacies and providers to resolve issues
• Maintain detailed documentation and support audits and quality reviews

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 in pharmacy claims billing and adjudication