PrudentRx Claims Specialist
About The Position
PrudentRx is seeking a detail-oriented professional for the Claims Specialist role. This position is ideal for someone who thrives in a structured and predictable work environment and remains calm and focused while verifying and validating data from reliable sources. The successful candidate will demonstrate sound judgment, take a thoughtful approach to decision-making, and minimize risk through strict adherence to established processes and procedures. This role plays a critical part in ensuring client and member data is processed accurately, efficiently, and securely throughout the entire implementation lifecycle. As a key contributor, the Claims Specialist will consistently uphold PrudentRx’s core values of accountability, dependability, professionalism, and service excellence. Minimum 1 year employment with PrudentRx and being in good standing (not on corrective action or performance improvement plan) are also required for this position.
Requirements
- Experience as a health care claims processor or in a medical facility billing office where COB verification is an integral function is a plus
- Demonstrated knowledge of, and proficiency in, Word, Excel, and Outlook required
- Flexibility and ability to manage multiple tasks
- Demonstrated organizational skills and attention to detail
- Ability to work effectively with a variety of people both within and outside of the organization by phone, via webinar and email
Nice To Haves
- 1 – 3 years pharmacy claims processing experience
Responsibilities
- Review and analyze claims to identify claims that may have been improperly billed to the COB plan for further investigation
- Ensures data is accurate and updated for efficient claims processing
- Monitor claims to ensure co-pay cards are utilized and billed properly
- Research, identify, and communicate errors
- Verify co-pay card fund availability
- Maintain current knowledge of various types of COB and third-party payer rules
- Meet all regulatory, contractual, or other requirements
- Other duties as assigned
Benefits
- Health
- Dental
- Vision
- STD, LTD, Critical Illness and Accident
- Company Paid Life Insurance
- 401(k) 100% company match up to 4%
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
