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Job Description
- Review and process medical claims according to insurance policies and regulations.
- Handle disputes or issues arising from claims denials or underpayments.
- Ensure accurate documentation and collection of all required paperwork during the
fulfillment process. - Analyze prescription trends and provide feedback for continuous improvement.
- Conduct regular audits of claims and prescriptions for compliance and accuracy.
- Generate reports on claims processing metrics and patient satisfaction for management.
- Maintain compliance with regulatory requirements and company policies.
Job Requirements
- Bachelor’s degree in Pharmacy.
- Exemption from any current governmental mandates.
- 2+ years of experience in a similar role, familiarity with medical claims processing and insurance
reimbursement procedures is a plus - Strong interpersonal and negotiation skills.
- Ability to thrive in a fast-paced environment and manage stress effectively.
- Detail-oriented with strong organizational skills.
- Ability to work both independently and as part of a team.
- Fluency in English (written and spoken).
- Proficiency in Microsoft Office, especially Excel.