Pharmacy Claims Representative

Job Summary

Working remotely in a full-time capacity, the Pharmacy Claims Representative will review, analyze, and process pharmacy claims while ensuring compliance with company and regulatory standards, and will communicate with pharmacies and providers to resolve discrepancies.

Key responsibilities

• Review and process pharmacy claims accurately and timely
• Investigate claim issues and communicate with relevant parties to resolve discrepancies
• Maintain detailed documentation to 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 or equivalent; associate degree preferred
• Experience working in a pharmacy environment