Claims Analyst- Remote Pharmacy Benefits

Description

This role is responsible for performing basic and intermediate level client, member and pharmacy remediation analysis caused by errors coded into the RxClaim processing system, along with claims monitoring and data validation activities. The research and remediation steps can vary based on the issue so this person must be very thorough and detailed. Research and analyze information by employing analytics and data science techniques to research and validate errors, isolate impacted claims, reprocess claims, and determine financial impact to members, health plans and/or pharmacies; translate data into usable client facing reports. The more research and auditing experience they have the more they will succeed in this role. The understanding of medical terminology (Copays, deductibles, and benefit plans) will help them in this role.

Skills

Claims, RxClaims, Pharmacy benefits, Health insurance, Claims Analyst, Audit, support, analysis, workflow, claim, Healthcare, Medical Terminology

Top Skills Details

Claims, RxClaims, Pharmacy benefits, Health insurance, Claims Analyst, Audit,Support, analysis

Additional Skills & Qualifications

High school diploma

Bachelors or associates preferred

2+ years of claims experience with emphasis on researching / auditing not processing or production

Claims software experience with RxClaims being preferred

Experience Level

Intermediate Level