Pharmacy Claims Professional 2

Profile

Description

The Pharmacy Claims Professional 2 monitors and ensures appropriate adjudication of pharmacy claims. The Pharmacy Claims Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Pharmacy Claims Professional 2 analyzes and answers inquiries regarding pharmacy claims adjudication(benefits and eligibility), including method of payment, co-pay or deductible amounts, and/or reason for denial. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

At least 2 years of data analysis & problem solving skills

Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint

Strong verbal and written communication skills, including the ability to tailor communication to audience

Strong organizational and time management skills

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

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

Preferred Qualifications

Previous experience with pharmacy benefits management

Claims experience

Previous experience in project work (IT/Vendors, etc.)

Pharmacy Tech experience

Additional Information

Scheduled Weekly Hours

40

Company info

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