The Pharmacy Claims Representative works to locate, obtain and maintain financial assistance for Humana Specialty Pharmacy patients. The Representative will handle inbound and outbound calls from patients and physicians to run and troubleshoot claims.
The Pharmacy Claims Representative 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.
1+ years customer service experience
1+ years inbound/outbound call experience
Must be computer savvy with Windows operations experience
Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint
Strong verbal and written communication skills, including the ability to tailor communication to audience
Must be able to demonstrate compassion and empathy for Humana Specialty Pharmacy users
Strong organizational and time management skills
Must be willing to be developed
Ability to handle multiple tasks, meet deadlines, and follow-up timely
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Previous experience with pharmacy benefits management
Pharmacy Tech experience
Case management skills
Remote work at home position in Ohio, Texas, Florida or Arizona. Will not consider candidates outside of these states.
Hours: Monday-Friday, 8 hour shift between 8am and 8pm EST. Mandatory OT required during peak season.
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Scheduled Weekly Hours