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
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.
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
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
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
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
- 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].