Pharmacy Claims Representative 2

By | October 7, 2022

Job Responsibilities : Pharmacy Claims Representative 2

Salary : $50490 per year

Company : CenterWell

Location : Remote US

Educational requirements : High School

The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.


The Pharmacy Claims Representative 2 analyzes and answers inquiries regarding pharmacy claims adjudication including method of payment co-pay or deductible amounts and/or reason for denial. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards but has some latitude over prioritization/timing and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

The role will also involve collaboration and sourcing of Patient Assistance in conjunction with Claim Processing duties.

Must be available to work an 8 hour shift within office hours of 8am-11pm. Shift will most likely be 9:00am – 5:30pm.

Required Qualifications

  • Must live in Arizona Ohio Florida or Texas.
  • Typically requires High School Diploma or equivalent.
  • Previous experience in the healthcare industry.

COVID 19 Vaccination:

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field regardless of vaccination status must complete a daily health screening questionnaire.

Interview Format:

As part of our hiring process for this opportunity we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number if it is not already on file. When required an email will be sent from with instructions to add the information into the application at Humana’s secure website.

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours


Not Specified


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