Medical/Pharmacy Claims Analyst - Remote | WFH

Join our Operations team, where we're revolutionizing healthcare. As a Medical/Pharmacy Claims Analyst, you'll play a crucial role in monitoring and analyzing medical claims processed through our clearinghouse. Our team values collaboration and accuracy, ensuring our processes never compromise patient care.

Key Responsibilities

Review and reconcile medical claims submitted daily via our clearinghouse to ensure successful payer receipt.

Evaluate claims for payment accuracy based on processing rules.

Identify and resolve denied or inaccurately paid claims, working closely with Pharmacy Support and Client Services.

Proactively communicate issues to maintain seamless daily claims operations.

Willingness To Assist With Additional Tasks As Required.

Commitment to maintaining confidentiality and securing sensitive healthcare information under HIPAA guidelines.

Qualifications

2+ years of experience in healthcare claims and related transactions.

Knowledge of medical and/or pharmacy billing and coding preferred.

Familiarity with X12 and NCPDP transaction formats preferred; SQL knowledge is a plus.

Strong communication, problem-solving, and detail-oriented skills essential for managing significant claim volumes and ongoing issue resolution.

Benefits & Perks

Comprehensive healthcare coverage (medical, dental, vision).

Paid holidays and unlimited paid time off.

401(k) savings plan with company match.

Remote work options with flexibility to work in-office as needed.

Employment Type: Full-Time