Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Senior Medicare Claims Specialist - RemoteJob Description

The Claims Specialist Senior role is responsible for the operational support of key Prime Service offerings. This position is responsible for examining and researching production issues and providing responses to internal business partners and external clients. This position will serve as an escalation resource and mentor for Claims Specialists.

Responsibilities

Leverage strong understanding of claims processing to provide research support for products; assist in resolution of business and technical problemsIdentify, evaluate process improvements; update documentation processes, procedures, and/or legally mandated claim requirements and communicate changes internally and externallyIdentify and document system defects related to products supported; escalate system defects to IT to avoid member disruption and promote client and member satisfactionServe as the escalation point for Claims Specialist; provide guidance and mentoring to ensure team member’s knowledge on system capabilities remains currentParticipate on cross-functional and/or department projects and provide consultative support to meet established deadlinesOther duties as assigned

Minimum Qualifications

High school diploma from accredited institution or equivalent GED3 years of experience in healthcare, PBM industry or related field1 year of claims experienceMust be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

Experience with Microsoft Office productsAbility to work in a fast-paced, collaborative, team environmentStrong verbal and written communication skillsStrong organizational and time management skillsProblem solving skills with ability to be attentive to detailStrong interpersonal communication skills and ability to effectively communicate with, and influence others to achieve desired resultsFlexibility in job duties with ability to work on multiple tasks simultaneously

Preferred Qualifications

Bachelor’s degree in Business, Communications or related area of studyPrevious experience working with RxCLAIMExperience in PBM industryExperience with Medicare Part DExperience using Microsoft Office products, specifically Excel and reporting capabilities

Minimum Physical Job Requirements

Constantly required to sit, use hands to handle or feel, talk and hearFrequently required to reach with hands and armsOccasionally required to stand, walk and stoop, kneel, and crouchOccasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 poundsSpecific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

Reports to a Supervisor or Manager in the PBM Operations department

Potential pay for this position ranges from $22.88 - $32.40 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Positions will be posted for a minimum of five consecutive workdays.