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
2+ years of customer service experience (working in an inbound and outbound call environment)
Strong verbal and written communication skills, including the ability to tailor communication to audience
Comprehensive knowledge of Microsoft Products including Word, Excel and Outlook
Intermediate to High level of Windows Based system navigation
Strong organizational and time management skills
Ability to handle multiple tasks, meet deadlines, and follow-up timely
Must be able to work a shift between 8am and 8pm EST Monday-Friday
Bachelor’s Degree in Finance, Accounting or a related field
Previous Healthcare and/or Mail Order Pharmacy experience
Previous claims experience
Fluency in Spanish
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination or commit to testing protocols OR
Provide proof of applicable exemption including any required supporting documentation
Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours