Remote Claims Specialist

Job Summary

Working remotely on a full-time basis, the Claims Specialist will manage and resolve pharmacy claims to ensure clients receive optimal reimbursement and support in a non-retail pharmacy environment.

Key responsibilities

• Manages a portfolio of rejected pharmacy claims to maximize payer reimbursement and timely billing
• Researches and resolves rejected claims by collaborating with Medicare D plans, third-party insurers, and state Medicaid plans
• Monitors revenue risks associated with payer setups and billing processes, ensuring accurate claims submissions

Required qualifications

• High School Diploma or GED required; Associate's or Bachelor's Degree preferred
• Customer service experience required; up to one year of related experience preferred
• Basic math aptitude and proficiency in Microsoft Office Suite
• Ability to retain and apply a large amount of information in a fast-paced environment
• Pharmacy technician experience or knowledge of pharmaceuticals is a strong preference