Senior Pharmacy Claims Professional

Profile

Description

The Senior Pharmacy Claims Professional adjudicates pharmacy claims and process pharmacy claims for payment. The Senior Pharmacy Claims Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Pharmacy Claims Professional analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

Bachelor's degree

3-5 years of data analysis & problem solving regarding process and work flow concepts

Demonstrated proficiency in MS Office applications including Access, Excel, Project and Visio

Strong consultative skills and relationship building skills

Strong verbal and written communication skills

Strong organizational and time management skills

Ability to handle multiple tasks, meet deadlines, and follow-up timely

Ability to work in a fast paced, dynamic and changing environment while managing multiple projects simultaneously

Strong attention to detail

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Pharmacy point of sale logic experience

Project testing including building scenarios

Previous experience with pharmacy claims

Proven experience with process engineering

Additional Information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com