Top 853 Claims Rep Jobs

Pharmacy Network Rep
ProCare Rx —Gainesville, GA
- Full-time
- Microsoft Outlook
- Research
- Mid-level
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Patient Account Rep, Denials
Vaco by Highspring —Los Angeles, CA
- $25 - $27 an hour
- Temporary
- Hospital
- Mid-level
- In-person
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General Liability Claims Adjuster ll - NY Adjuster License (40350)
IOS Staffing Services —Remote
- $36.00 - $60.10 an hour
- Full-time
- Remote
- Background check
- 5 years
- Apartments
- Referral program
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1d
Denials Representative
Insight Global —Torrance, CA
- $25 - $28 an hour
- Contract
- Background check
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
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5d
Patient Financial Services Rep
MedHQ, LLC —Remote
- $15 - $18 an hour
- Full-time
- Surgery
- HIPAA
- Research
- Disability insurance
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Claims Examiner Remote
NTT Ltd —Plano, TX
- Overtime
- Remote
- Computer literacy
- Basic math
- English
Claims Administrative Assistant
Stellar Human Resource Services LLC —Miami, FL
- Full-time
- Office
- Entry level
Quick Apply
Accounts Receivable Rep- 3rd Party Non-Gov't payers
TridentCare —Sparks, MD
- $0.01 - $999.00 an hour
- Remote
- Computer literacy
- High school diploma or GED
- Analysis skills
- Paid holidays
- Disability insurance
Patient Account Rep I
Radiology Partners —Remote
- $19 - $22 an hour
- Full-time
- HIPAA
- Mid-level
- 3 years
- Paid holidays
- Health insurance
Quick Apply
Dental CS Rep I (***)
Moda Health —Portland, OR
- $18.39 - $20.58 an hour
- Weekends as needed
- Hybrid work
- Medical office experience
- HIPAA
- High school diploma or GED
- Paid holidays
- Health insurance
Quick Apply
Patient Accounts Rep I
Seattle Roots Community Health —Seattle, WA
- $22.74 - $33.95 an hour
- Full-time
- Bilingual
- Background check
- Microsoft Excel
- Disability insurance
- Health insurance
Quick Apply
Entry-Level Sales Rep (Remote Work)
Agent Integration —New York, NY
- $60,000 - $65,000 a year
- Full-time
- Remote
- Entry level
- Paid training
- Dental insurance
Quick Apply
10d
New Claims Coordinator
Stellar Human Resource Services LLC —Miami, FL
- Full-time
- Mid-level
Quick Apply
PATIENT ACCOUNT REP
Pomona Valley Hospital Medical Center —Pomona, CA
- $23.00 - $30.89 an hour
- 8 hour shift
- Hospital
- High school diploma or GED
- Data entry
Remote Entry-Level Inside Sales Rep
Agent Integration —Staten Island, NY
- $60,000 - $65,000 a year
- Full-time
- Remote
- Entry level
- Paid training
- Dental insurance
Quick Apply
Clm Resltion Rep III, Hosp/Prv
University of Rochester —Albany, NY
- $20.30 - $27.41 an hour
- Full-time
- Remote
- Research
- Mid-level
- Associate's degree
PATIENT ACCOUNT REP I CORPORATE
Covenant Health —Knoxville, TN
- Full-time
- HIPAA
- High school diploma or GED
- Computer skills
Medical CS Rep I (***)
Moda Health —Portland, OR
- $18.39 - $20.58 an hour
- Weekends as needed
- Hybrid work
- High school diploma or GED
- Math
- Typing
- Paid holidays
- Health insurance
Quick Apply
Accounts Payable Representative , Chain Claims(Temp to Hire)
Monster Energy —Los Angeles, CA
- $18 - $24 an hour
- Microsoft Outlook
- Word processing
- Office
Quick Apply
Clm Resltion Rep II, Hosp/Prv
University of Rochester —Rochester, NY
- $19.72 - $26.62 an hour
- Full-time
- Hybrid work
- Research
- Mid-level
- Office

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Pharmacy Network Rep

ProCare Rx -
Gainesville, GA

Quick Apply

Job Details

Full-time

Qualifications

Contract documentation review
Contract review
Contract interpretation
Research
Desktop applications
Document viewing software

Full Job Description

ESSENTIAL DUTIES AND RESPONSIBLITIES include but are not limited to the following:
● Ensure pharmacy networks comply with state-specific pharmacy regulations and communicate the regulatory changes to
internal & external stakeholders
● Assist with the implementation of new requirements while functioning as the internal subject matter expert (SME) on state
requirements that may affect pharmacy operations and participation while assisting with the implementation of state
requirements.
● Work with the Legal and Compliance team to assist with regulatory state audits, Corrective action plans and reporting.
● Guarantee pharmacy networks and operational processes are in alignment with state rules and regulations
● Provide day-to-day operational support for pharmacy questions via phone and/or email.
● Responsible for Pharmacy Relations emails; respond to requests and questions from pharmacies in a timely manner.
● Initiate and tracks contract from initial draft to full execution.
● Provide written and/or verbal contractual education for pharmacies as needed.
● Target and recruit additional pharmacies to meet Plan network adequacy requirements and/or requests.
● Participate in re-contracting efforts as required and directed.
● Update multiple systems with contract data and demographic information, as required.
● Submit pricing changes to the Quality Assurance team.
● Preform pharmacy research to ensure company credentialing standards are met.
● Investigate simple pharmacy claim issues, help resolve pharmacy issues and complaints.
● Communicate with the MAC/Reimbursement team as required.
● Prepare documentation for audits, as requested by manager.
● Attend meetings for new plan implementations.
● Ensure deliverables are on time and meet quality levels as expected by ProCare’s internal and external customers.
● Coordinate and follow up on pharmacy network fax/email blasts as required.
● Responsible for monthly import reports and weekly cascading of data through various systems.

● Must have the ability to interpret regulatory language and translate the regulatory changes into operational requirement
● Knowledge of state pharmacy regulations is helpful.
● Must be a strong team player who can adapt to a team environment and work independently in a fast-paced environment.
● Must be able to work in multiple computer systems simultaneously on a daily basis.
● Excellent telephone etiquette and verbal/written communication skills.
● Must be highly organized, motivated, take initiative and possess a willingness to learn new processes.
● Extreme attention to detail required.
● Working knowledge of computers and related software applications such as Word, Excel, Adobe and Outlook a must.
● Must be able to review contracts and learn the differences of each contract.

EDUCATION AND EXPERIENCE

Associate’s Degree with two years of experience in a health care setting working with contracts, regulatory compliance and/or
provider relations preferred. PBM experience a plus.

PHYSICAN DEMANDS
Requires sitting, standing, and occasional light lifting.

This is a full-time position with benefits. Please visit our Contact Us/Opportunities page on our website for more information about our benefits list.

ProCareRx 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]).

ProCareRx 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.

Quick Apply

Refine Your Search

Claims Rep jobs

Pharmacy Network Rep

Patient Account Rep, Denials

General Liability Claims Adjuster ll - NY Adjuster License (40350)

Denials Representative

Patient Financial Services Rep

Claims Examiner Remote

Claims Administrative Assistant

Accounts Receivable Rep- 3rd Party Non-Gov't payers

Patient Account Rep I

Dental CS Rep I (***)

Patient Accounts Rep I

Entry-Level Sales Rep (Remote Work)

New Claims Coordinator

PATIENT ACCOUNT REP

Remote Entry-Level Inside Sales Rep

Clm Resltion Rep III, Hosp/Prv

PATIENT ACCOUNT REP I CORPORATE

Medical CS Rep I (***)

Accounts Payable Representative , Chain Claims(Temp to Hire)

Clm Resltion Rep II, Hosp/Prv

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