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 accuracy and compliance with company and regulatory standards.

Key responsibilities

• Review and process pharmacy claims with accuracy and timeliness
• Identify and resolve discrepancies in claims by communicating with pharmacies and providers
• 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
• Experience with pharmacy claims adjudication
• High school diploma or equivalent; associate degree preferred
• Proficiency in claims processing platforms and Microsoft Office tools