Pharmacy Claims Representative

Job Summary

Working remotely in a full-time capacity, the Pharmacy Claims Representative will review, analyze, and process pharmacy claims accurately while adhering to company and regulatory standards, with a schedule of Monday to Friday from 2:30 PM to 11:00 PM EST and every fourth weekend rotation.

Key responsibilities

• Review and process pharmacy claims, ensuring accuracy and compliance with regulations
• Investigate discrepancies and resolve claim issues by communicating with pharmacies and providers
• 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
• Strong analytical and organizational skills
• Proficiency in claims processing platforms and Microsoft Office tools
• High school diploma or equivalent; associate degree preferred