Pharmacy Claims Specialist

1 day ago


Cebu City, Central Visayas, Philippines beBeePharmacy Full time ₱250,000 - ₱450,000

Pharmacy Claims Specialist

We are seeking a detail-oriented professional to join our team as a Pharmacy Claims Specialist. This role involves reviewing and analyzing pharmacy claims to ensure compliance with regulations and company standards.

About the Role
  • This position is responsible for verifying claims data, identifying discrepancies, and supporting audit processes to maintain the accuracy and integrity of our claims systems.
  • You will work closely with pharmacy providers, communicating with them to resolve issues and requesting claim adjustments when necessary.
Responsibilities
  • Review pharmacy claims against company policies and regulatory guidelines to identify errors or potential fraud.
  • Document audit support findings, prepare reports, and maintain accurate records of communications.
  • Prepare correspondence and coordinate with internal teams to support the provider audit process.
Requirements
  • High school diploma (or equivalent) required; Associate degree or college coursework preferred.
  • At least 1 year of experience in a pharmacy setting and 1 year of administrative or customer service experience.
  • Working knowledge of Microsoft Office (Word, Excel) and familiarity with database systems.
What We're Looking For
  • Adaptability and problem-solving skills in fast-paced environments.
  • Strong professionalism, customer focus, and commitment to accuracy.
  • Ability to handle multiple priorities and meet deadlines.


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