Claims Specialist
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Job Description
Claims Specialist handling health care claims processing at PrudentRx. Ensure accurate data processing and monitor claims for discrepancies in a remote work environment.
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
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
- Preferred 1 – 3 years pharmacy claims processing experience
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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