[Hiring] Pharmacy Claims Representative 2 @CenterWell

Role Description

Become a part of our caring community. The Pharmacy Claims Representative 2 adjudicates pharmacy claims and processes pharmacy claims for payment. The Pharmacy Claims Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Use your business knowledge to help analyze data and provide financial support. Humana is seeking a Patient Finance Specialist that will work on the behalf of CenterWell Specialty Pharmacy customers, develop relationships with foundations and manufacturers, and provide internal customer support for the entire Pharmacy.

• Location: Remote Arizona or Ohio only
• Shift: Must be able to work an 8 hour shift between 8am and 8pm EST Monday-Friday. Overtime may be required during peak season.

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 focused 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.

• Source Patient Assistance programs and/or foundations to assist patients in meeting Out of Pocket responsibility
• Take inbound and make outbound calls related to Patient Assistant Programs, billing inquiries, and insurance verification
• Provide customer service (internal/external)
• Documenting case files with complete notes on work
• Complete special projects with varied and complex components as needed

Qualifications

• 1 or more years of customer service experience handling both incoming and outgoing phone calls in a professional setting
• Comprehensive knowledge of Microsoft Products including Word, Excel and Outlook
• Intermediate to High level of Windows Based system navigation

Requirements

• Bachelor’s Degree in Finance, Accounting or a related field
• Pharmacy Technician Certification
• Previous Healthcare and/or Mail Order Pharmacy experience
• Pharmacy Claims experience
• Fluency in Spanish

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Company Description

About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.