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.
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.
Use your business knowledge to help analyze data and provide financial support. Humana is seeking a Patient Finance Specialist that will work on the behalf of Humana customers, develop relationships with foundations and manufacturers, and provide internal customer support for the entire Pharmacy. In this role you will:
· 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
High school diploma or GED
1 to 2 years of customer service experience
Previous experience working phones on an incoming or outgoing basis (call center)
Comprehensive knowledge of Microsoft Products including Word, Excel and Outlook
Intermediate to High level of Windows Based system navigation
Must be able to work a shift between 8am and 8pm EST Monday-Friday and Saturdays between 8am to 6:30pm (Weekday off if you work Saturdays).
Bachelor’s Degree in Finance, Administration, or a related field
Strong communication and telephonic skills (including soft skills and de-escalation)
Previous Healthcare and/or Mail Order Pharmacy experience
Fluency in Spanish
You will report to a Finance Frontline Leader. This area is under the leadership of the SVP & Chief Financial Officer.
At Humana, we’re also committed to making the resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. We know your well-being is important to you, and it’s important to us too.
Scheduled Weekly Hours
Equal Opportunity Employer
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