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
• Investigate claim discrepancies and communicate with pharmacies and providers to resolve issues
• 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 required; associate degree preferred