Pharmacy Claims Representative (remote)
Our client operates in the care-at-home healthcare sector, specializing in durable medical equipment (DME) and pharmacy solutions. They address challenges in hospice and post-acute care by leveraging advanced technology and analytics to provide integrated services that support caregivers, patients, and families. Serving more than 145,000 patients daily across all 50 states, the company focuses on delivering efficient healthcare solutions with an emphasis on comfort and peace of mind.
About the role
This position is responsible for ensuring accurate and timely processing of pharmacy claims within a remote call center environment. The role plays an important part in maintaining patient access to care by investigating and resolving claim issues, supporting compliance requirements, and facilitating communication among pharmacies, providers, and internal teams. The position contributes to operational efficiency through accurate claims processing, documentation, and identification of process improvement opportunities.
Responsibilities
- Review, analyze, and process pharmacy claims accurately and promptly.
- Identify discrepancies and investigate claim issues to determine appropriate resolutions.
- Communicate with pharmacies, providers, and internal teams to clarify information and correct errors.
- Maintain detailed and accurate documentation to support audits and quality reviews.
- Identify recurring trends and provide insights to improve claims processing efficiency.
- Ensure compliance with HIPAA requirements and company policies when handling patient information.
Requirements
- 1–2 years of experience in pharmacy claims processing or healthcare operations.
- Knowledge of pharmacy billing procedures, insurance verification, and third-party payer systems.
- Strong analytical, organizational, and data-entry skills.
- Proficiency with claims processing platforms and Microsoft Office applications.
- Professional verbal and written communication skills when working with providers and team members.
- Strong attention to detail and commitment to accuracy.
Pay
- Base pay of $22.00 per hour.
- 12% shift differential for hours worked after 6:00 PM on weekdays.
- 5% shift differential for weekend hours.
Benefits
- Comprehensive health, dental, and vision insurance.
- Paid time off and sick time.
- 401(k) retirement plan with company match.
- Opportunities for career growth and advancement.
- Supportive and adaptable team culture.
- Access to innovative healthcare technology solutions.