
Pharmacy Claims Specialist
1 day ago
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.
- 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.
- 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.
- 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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