Top 71370 Claim Program Jobs

Reimbursement Analyst
ProCare Rx —Gainesville, GA
- Writing skills
- Mid-level
- Finance
- Wellness program
- Paid holidays
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Program Specialist II (Investigator II)
Galt Foundation —Oklahoma City, OK
- $25 an hour
- Contract
- Working with individuals with disabilities
- Mid-level
- Office
- Health insurance
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Program Officer - SW
Claims Conference —New York, NY
- $80,000 - $85,000 a year
- Hybrid work
- Mid-level
- Analysis skills
- Travel
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Junior Claims Specialist (1-3 years) (Hybrid in Berkeley Heights, NJ) (Full-Time)
Career Developers —Berkeley Heights, NJ
- $75,000 - $85,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Mid-level
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9d
Total Absence Management Claim Specialist
MetLife —Remote
- $45,500 - $80,169 a year
- Email
- High school diploma or GED
- Bachelor's degree
- US work authorization
- Paid holidays
- Disability insurance
Absence Management Claim Specialist
MetLife —Remote
- $41,600 - $80,169 a year
- Email
- High school diploma or GED
- Bachelor's degree
- US work authorization
- Paid holidays
- Disability insurance
11d
Financial Advisor - Missoula / Butte / Great Falls / Havre / Kalispell / Billings / Helena / Bozeman and surrounding areas
Thrivent —Butte, MT
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
Quick Apply
Mechanical Claims Adjuster
Buckeye Risk Services —Colorado
- From $60,000 a year
- Full-time
- Remote
- ASE Certification
- Background check
- Spanish
- Health insurance
- Dental insurance
Quick Apply
Team-Based Financial Advisor - Apex Financial Group (Fond du Lac)
Thrivent —Fond du Lac, WI
- $24,000 a year
- Full-time
- Microsoft Word
- Background check
- Microsoft Excel
- AD&D insurance
- Health insurance
Quick Apply
Financial Advisor - Northern Highland Financial Advisors
Thrivent —Stevens Point, WI
- $90,198 - $165,000 a year
- Full-time
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
Quick Apply
Financial Advisor - Eastern Iowa/Cedar Rapids/Quad Cities
Thrivent —Cedar Rapids, IA
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
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Associate Financial Advisor - Wisconsin Heartland Associates
Thrivent —Stoughton, WI
- $36,000 a year
- Full-time
- Background check
- Mid-level
- Office
- 401(k)
Quick Apply
Financial Advisor - Milwaukee, WI and Surrounding Areas
Thrivent —Milwaukee, WI
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
Quick Apply
Financial Advisor - Bismarck/Mandan
Thrivent —Bismarck, ND
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
Quick Apply
Financial Advisor - NE - Omaha
Thrivent —Omaha, NE
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
Quick Apply
Financial Advisor - Green Bay, WI and Surrounding Areas
Thrivent —Green Bay, WI
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
Quick Apply
Financial Advisor - SD - Sioux Falls
Thrivent —Sioux Falls, SD
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
Quick Apply
Financial Advisor - Madison and Surrounding Areas
Thrivent —Madison, WI
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
Quick Apply
Financial Advisor – Fort Wayne, IN and surrounding areas
Thrivent —Fort Wayne, IN
- Background check
- Mid-level
- Business development
- Paid training
- AD&D insurance
Quick Apply
Team-Based Financial Advisor - Holder & Albrecht Financial Group
Thrivent —Spokane, WA
- $60,000 - $80,000 a year
- Full-time
- Microsoft Word
- Background check
- Microsoft Excel
- AD&D insurance
- Health insurance
Quick Apply

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Reimbursement Analyst

ProCare Rx -
Gainesville, GA

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Job Details

Benefits

Wellness program
Paid holidays
Disability insurance
Health insurance
Dental insurance
Employee assistance program
Vision insurance
401(k) matching
Life insurance
Referral program

Qualifications

Appeals
Contract documentation review
Contract review
Economics
Health data analysis
Legal analysis
Finance
SAS
Bachelor's degree in finance
Spreadsheets
Writing skills
Data quality assurance
Contract performance monitoring
Bachelor's degree in economics
Mid-level
State healthcare regulations
Contract management experience in healthcare
Trend analysis
Finance
SQL
Analysis skills
Bachelor's degree
Pricing analysis experience within healthcare industry
Data-driven problem-solving
Profitability analysis
Contract management support tasks
Query management
Business
Financial data analysis tools
Health economics data analysis

Full Job Description

PRINCIPLE RESPONSIBILITIES (include but are not limited to):

Analyze pharmacy claims data utilization to identify financial trends, opportunities, and potential risks, including changes to profit margins.
Work with Pharmacy Network to identify new contract requirements and methods to validate set up in the system.
Perform scheduled review and quality assurance of reimbursement in the system.
Assist the legal team by monitoring, understanding, and acting on state MAC laws.
Monitor and maintain contractual Generic Effective Rate agreements.
Assist with implementation of new MAC tables for new clients.
Assist with MAC review appeals from pharmacies & clients.
Communicate MAC prices of new drugs with other team members.

REQUIREMENTS

Bachelor’s degree in Finance, Economics or other business-related field, or 4+ years of financial or pricing analysis experience in PBM or Healthcare related field preferred.
Demonstrate expanded understanding of advanced Excel functionality preferred.
Aptitude to learn or demonstrated understanding of databases and query languages (e.g., SQL, DBF, Access, SAS, etc.) preferred.
Ability to effectively communicate, verbally and in writing, potentially technical information to a non-technical audience preferred.
Ability to work independently and in a fast-paced environment preferred.
Strong analytical and problem-solving skills preferred.

PHYSICAL DEMANDS

Requires sitting, standing, and occasional light lifting.

The Perks of Joining Our Team:

We believe in taking care of our team. You'll enjoy a comprehensive benefits package designed to support your well-being and financial future:

Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
Time to Recharge: Paid vacation and holiday pay.
Focus on Your Wellness: We offer a robust Employee Wellness Program.
Invest in Your Future: 401 k with a company match.
Support System: Employee Assistance Program provides confidential support and counseling.
Get Rewarded for Referring Great People: Employee referral program.

ProCare Rx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at [email protected] (mailto:[email protected]).

ProCare Rx is an Equal Opportunity Employer.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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Refine Your Search

Claim Program jobs

Reimbursement Analyst

Program Specialist II (Investigator II)

Program Officer - SW

Junior Claims Specialist (1-3 years) (Hybrid in Berkeley Heights, NJ) (Full-Time)

Total Absence Management Claim Specialist

Absence Management Claim Specialist

Financial Advisor - Missoula / Butte / Great Falls / Havre / Kalispell / Billings / Helena / Bozeman and surrounding areas

Mechanical Claims Adjuster

Team-Based Financial Advisor - Apex Financial Group (Fond du Lac)

Financial Advisor - Northern Highland Financial Advisors

Financial Advisor - Eastern Iowa/Cedar Rapids/Quad Cities

Associate Financial Advisor - Wisconsin Heartland Associates

Financial Advisor - Milwaukee, WI and Surrounding Areas

Financial Advisor - Bismarck/Mandan

Financial Advisor - NE - Omaha

Financial Advisor - Green Bay, WI and Surrounding Areas

Financial Advisor - SD - Sioux Falls

Financial Advisor - Madison and Surrounding Areas

Financial Advisor – Fort Wayne, IN and surrounding areas

Team-Based Financial Advisor - Holder & Albrecht Financial Group

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