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.

Responsibilities

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 Humana@myworkday.com 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

40

Not Specified

0

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