Cincinnati Jobs ‹ Pharmacy Claims Representative 2 at Humana - Feb, 2022

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. Performs computations. Typically works on semi-routine assignments.

Responsibilities

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.

The role will also involve collaboration and sourcing of Patient Assistance in conjunction with Claim Processing duties.

Required Qualifications

• Must be available to work an 8 hour shift within office hours of 8am-8pm. Shift will most likely be 9:00am - 5:30pm est.
• Strong computer navigation skills
• Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role), recommended speed is 10Mx1M
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Typically requires High School Diploma or equivalent.
• Previous experience in the healthcare industry.
• Medical or pharmacy benefit claim processing experience is ideal.

Scheduled Weekly Hours

40