Job Description

Description

The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Pharmacy Claims Representative 2 analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

The role will also involve collaboration and sourcing of Patient Assistance in conjunction with Claim Processing duties.

Must be available to work an 8 hour shift within office hours of 8am-8pm est. Shift will most likely be 11:30am - 8:00pm est.

Required Qualifications

* At least 1+ years of experience working in a medical, insurance or pharmacy claims environment.
* High School Diploma
* Less than 2 years of technical experience
* Less than 5 years of data analysis & problem solving skills
* Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint
* Strong verbal and written communication skills, including the ability to tailor communication to audience
* Strong organizational and time management skills
* Ability to handle multiple tasks, meet deadlines, and follow-up timely
* 1+ years of experience working in an environment that requires meeting production metrics.
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

* Previous experience with pharmacy benefits management
* Rx Nova or ScriptMed experience a plus
* Claims experience
* Knowledge/experience working with SQL (via MS SQL Server, Oracle, PL/SQL or other)
* Pharmacy Tech experience

Additional Information

* This role is Work at Home; however candidates must live in Glendale, AZ or within a commutable distance to the facility.
* Work hours are between 11:30am-8:00pm; however work hours are subject to changed based on business needs. Rotational holiday coverage required (Will be required to work 1-2 holidays a year)
* Must have a private office to protect confidential information
* Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M

Scheduled Weekly Hours

40