Senior Claims Specialist - Full-time / Part-time

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Senior Claims Specialist

Job Description

The Claims Specialist Senior role is responsible for the operational support of key Prime Service offerings. This position is responsible for examining and researching production issues and providing responses to internal business partners and external clients. This position will serve as an escalation resource and mentor for Claims Specialists.

Responsibilities

• Leverage strong understanding of claims processing to provide research support for products; assist in resolution of business and technical problems
• Identify, evaluate process improvements; update documentation processes, procedures, and/or legally mandated claim requirements and communicate changes internally and externally
• Identify and document system defects related to products supported; escalate system defects to IT to avoid member disruption and promote client and member satisfaction
• Serve as the escalation point for Claims Specialist; provide guidance and mentoring to ensure team member's knowledge on system capabilities remains current
• Participate on cross-functional and/or department projects and provide consultative support to meet established deadlines
• Other duties as assigned

Minimum Qualifications

• High school diploma or GED from accredited institution or equivalent GED
• 3 years' experience in healthcare, PBM industry or related field
• 1 year claims experience
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Experience with Microsoft Office products
• Ability to work in a fast-paced, collaborative, team environment
• Strong verbal and written communication skills
• Strong organizational and time management skills
• Problem solving skills with ability to be attentive to detail
• Strong interpersonal communication skills and ability to effectively communicate with, and influence others to achieve desired results
• Flexibility in job duties with ability to work on multiple tasks simultaneously

Preferred Qualifications

• Bachelors degree in Business, Communications or related area of study
• Previous experience working with RxCLAIM
• Experience in PBM industry
• Formal experience identifying process improvements

Minimum Physical Job Requirements

• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

• Reports to a Supervisor or Manager in the PBM Operations department

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage qualified minority, female, veteran, disabled, and other diverse candidates to apply and be considered for open positions.