Prime Therapeutics Claims Specialist – Remote in Hartford, Connecticut

November 29, 2023

Job Description


Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Claims Specialist – Remote

Job Description

The Claims Specialist is responsible for assisting in the ongoing operational support of Prime key service offerings. This position is responsible for responding to inquires from internal and external partners for the research of and resolution of claim issues. Additionally, this position serves as a subject matter expert resource for coworkers and other departments.

Responsibilities

  • Work in Medicare, Commercial and Health Insurance Marketplace (HIM) integrity lines of business to ensure strict adherence to unique guidelines and regulations for each

  • Monitor and respond appropriately to incoming inquiries related to specific process or support systems (e.g. claim adjudication system) Escalate issues when appropriate

  • Partner with Prime’s clients to produce and execute corrective measures found in key service offerings

  • Process authorizations to meet HIPAA/privacy and CMS requirements

  • Sorts, researches and processes daily internal and external documents received by the mailroom.

  • Assist with RxClaim Release user acceptance testing and reporting

  • Serve as a subject matter expert (SME) resource for other departments

  • Other duties as assigned

Minimum Qualifications

  • High school diploma from accredited institution or equivalent GED

  • 1 year of claims experience

  • Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

  • Experience with Microsoft Office products

  • Strong written and verbal communication skills

  • Strong organizational skills

  • Ability to work independently

  • Strong attention to detail with ability to perform with high degree of accuracy

  • Ability to prioritize and handle multiple tasks simultaneously

Preferred Qualifications

  • 2+ years of experience in claims, insurance, or healthcare

  • Extensive experience using Excel spreadsheets

Minimum Physical Job Requirements

  • Constantly required to sit, use hands to handle or feel, talk and hear

  • Frequently required to reach with hands and arms

  • Occasionally required to stand, walk and stoop, kneel, and crouch

  • Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

  • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

  • Reports to a Supervisor or Manager in the PBM Operations department

Potential pay for this position ranges from $18.85 – $24.42 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the “Benefits at a glance” button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Prime Therapeutics’ fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today’s health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people’s lives.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [email protected].









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