Claims Specialist Jobs

About The Position

Requirements

• High school diploma or equivalent required.
• Two to four years of experience in pharmacy billing, claims processing, revenue cycle, payment posting, or insurance reconciliation.
• Experience with Medicaid, Medicare, and commercial insurance plans.

Nice To Haves

• Experience as a Certified Pharmacy Technician (CPhT) preferred.
• Associate degree in Healthcare Administration, Business, Accounting, Finance, Pharmacy Billing, or a related field is a plus.
• Experience reconciling pharmacy claims preferred.
• Pharmacy claims reconciliation experience is highly desirable.

Responsibilities

• Reconcile pharmacy claims and insurance payments by comparing expected reimbursements to actual payments and identifying discrepancies such as underpayments, overpayments, duplicate payments, and missing payments.
• Research and analyze claim denials, payment variances, and reimbursement trends to determine root causes and recommend corrective actions.
• Coordinate with pharmacy providers and other stakeholders to investigate and resolve payment discrepancies and outstanding billing issues.
• Support revenue cycle operations through claims reconciliation, reimbursement validation, month-end activities, audit documentation, and payment file reviews.
• Generate reports on reimbursement performance, denial trends, recovery opportunities, and payment activity while identifying process improvement and automation opportunities.

Benefits

• Comprehensive benefits including medical, dental, vision, paid time off, and 401k
• DailyPay, receive your money as you earn it!
• Tuition Assistance and dependent Scholarships
• Employee Assistance Program (EAP) including free counseling and health coaching
• Company paid life insurance
• Tax free Health Spending Accounts (HSA)
• Wellness program featuring fitness memberships and product discounts
• Preferred banking partnership and discounted rates for home and auto loans