Claims Specialist

• On-site fulltime
• • 40 hrs/week, rotating shifts 8 AM- 9 PM OR fixed shifts of 12 PM- 8 PM OR 1 PM- 9 PM
  • Mandatory Training first 6 -8 weeks from 10 AM- 6 PM
  • Availability for rotating Saturday shifts 9 AM- 5 PM (once a month)

Must Haves:

• High school diploma or GED required, Bachelor’s degree strongly preferred
• One year of Pharmacy Experience, having resolved third party claims OR Healthcare industry experience with claims background
• Strong technical aptitude and ability to learn complex new software

Day-to-Day:

A closed door pharmacy is looking to hire a Pharmacy Benefits Specialist. This role will include processing pharmacy claims, triaging rejected claims, and verifying benefits. Prior Pharmacy benefits experience is required as well as the ability to multitask.

Responsibilities:

• Process pharmacy claims accurately and timely to meet client expectations
• Triage rejected pharmacy insurance claims to ascertain patient pharmacy benefits coverage
• Maintain compliance with patient assistance program guidelines 
• Document all information and data discovery according to operating procedures
• Research required information using available resources
• Maintain confidentiality of patient and proprietary information
• Perform all tasks in a safe and compliant manner that is consistent with corporate policies as well as State and Federal laws
• Work collaboratively and cross-functionally between management, the Missouri-based pharmacy, compliance and engineering