[Hiring] Pharmacy Claims Representative 2 @Humana

Role Description

The Pharmacy Claims Representative 2 adjudicates pharmacy claims and processes pharmacy claims for payment. This role involves:

• Performing varied activities and moderately complex administrative/operational/customer support assignments.
• Analyzing data and providing financial support.
• Working on behalf of CenterWell Specialty Pharmacy customers.
• Developing relationships with foundations and manufacturers.
• Providing 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
• Reason for denial

Decisions are typically focused on interpretation of area/department policy and methods for completing assignments. The role works within defined parameters to identify work expectations and quality standards, with some latitude over prioritization/timing, and works under minimal direction. Standard policies/practices allow for some opportunity for interpretation/deviation and/or independent discretion.

Patient Finance Specialist detailed description:

• 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).
• Document 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 (desirable).
• Pharmacy Technician Certification (desirable).
• Previous Healthcare and/or Mail Order Pharmacy experience (desirable).
• Pharmacy Claims experience (desirable).
• Fluency in Spanish (desirable).

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service must meet the following criteria:

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps is required.
• Wireless, wired cable or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc.

$40,000 - $52,300 per year

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.

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.