Pharmacy Claims Representative 2- PSS - #1670633


Date: 27/09/2021
City: Rising Sun, IN
Contract type: Full time

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.


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.


  • Associates wi help members with financial assistance

  • A mix of phone and production based work

Required Qualifications

  • Must be available to work an 8 hour shift within office hours of 8am-11pm 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


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