Pharmacy Claims Representative

Job Summary

Pharmacy Claims Representative, responsible for processing pharmacy claims in a remote call center environment, working full-time with a schedule of Monday to Friday from 2:30 PM to 11:00 PM EST and every fourth weekend rotation.

Key Responsibilities

• Review, analyze, and process pharmacy claims accurately and timely
• Identify discrepancies and investigate claim issues to determine resolutions
• Communicate with pharmacies, providers, and internal teams to resolve errors and support audits

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
• CPhT or EXCPT certification preferred