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Pharmacy Claims Representative

Job Description

The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process 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 Humana customers, develop relationships with foundations and manufacturers, and provide internal customer support for the entire Pharmacy

Job Requirements

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 focus 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.
Patient Finance Specialist detailed description:



  • Source Patient Assistance program and/or foundation to assist patients in meeting Out Of Pocket responsibility

  • Take inbound and make outbound calls related to Patient Assistant Program, 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


               


Required Qualifications



  • High School Diploma or equivalent. Less than 3 years of technical and/or customer service experience.

  • A Saturday schedule (8am-430pm EST)  is requires with one day off through the week.


Scheduled Weekly Hours
40

Job Snapshot

Location US-OH-Springdale
Employment Type Full-Time Employee
Pay Type Year
Pay Rate N/A
Store Type Health Care, Insurance, Customer Service
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Company Overview

Humana

Throughout our 50-year history, Humana has always been one step ahead, constantly evolving with the changing world of healthcare. It is our proactive, forward-thinking approach that has allowed us to not only meet the needs of our customers, but also provide a challenging and exciting work experience for our associates.

Contact Information

US-OH-Springdale

Snapshot
Humana
Company:
US-OH-Springdale
Location:
Full-Time Employee
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care, Insurance, Customer Service
Store Type:

Job Description

The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process 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 Humana customers, develop relationships with foundations and manufacturers, and provide internal customer support for the entire Pharmacy

Job Requirements

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 focus 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.
Patient Finance Specialist detailed description:



  • Source Patient Assistance program and/or foundation to assist patients in meeting Out Of Pocket responsibility

  • Take inbound and make outbound calls related to Patient Assistant Program, 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


               


Required Qualifications



  • High School Diploma or equivalent. Less than 3 years of technical and/or customer service experience.

  • A Saturday schedule (8am-430pm EST)  is requires with one day off through the week.


Scheduled Weekly Hours
40

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