Customer Claims Representative

Profile

Description

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

Job Description

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.

Required Qualifications

Must be available to work an 8 hour shift within office hours of 8am-8pm. Shift will most likely be 10:00am - 6:30pm or 11:30am - 8:00pm Mountain Time.

Previous experience in the healthcare industry.

Excellent communication skills

Experience using multiple computer applications simultaneously

A positive, proactive attitude with a passion for customer service Preferred Qualifications

Typically requires High School Diploma or equivalent.

Medical and pharmacy benefit claim processing experience.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com