Pharmacy Claims Representative (remote)

Dragonfly Health•Mesa, AZ

3d•Remote

About The Position

In a remote call center environment, you will review, analyze, and process pharmacy claims with accuracy, timeliness, and adherence to company and regulatory standards. Identify discrepancies, investigate claim issues, and determine appropriate resolutions. Communicate effectively with pharmacies, providers, and internal teams to clarify information and resolve errors. Support audits and quality reviews by maintaining detailed, accurate claim documentation. Identify trends and share insights that can improve claim accuracy and efficiency. Uphold confidentiality and compliance with HIPAA and corporate policy standards.

Requirements

1–2 years of pharmacy claims or healthcare operations experience.
Working knowledge of pharmacy billing procedures, insurance verification, and third-party payer systems.
Strong analytical, organizational, and data-entry skills.
Proficiency in claims processing platforms and Microsoft Office tools.
Ability to communicate professionally with providers and team members.
High attention to detail and a commitment to getting it right the first time.

Responsibilities

Review, analyze, and process pharmacy claims with accuracy, timeliness, and adherence to company and regulatory standards.
Identify discrepancies, investigate claim issues, and determine appropriate resolutions.
Communicate effectively with pharmacies, providers, and internal teams to clarify information and resolve errors.
Support audits and quality reviews by maintaining detailed, accurate claim documentation.
Identify trends and share insights that can improve claim accuracy and efficiency.
Uphold confidentiality and compliance with HIPAA and corporate policy standards.