Claims Specialist Sr

Prime Therapeutics; Helena (MT); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare service provider in Helena, Montana, is seeking a Claims Specialist Sr. This role involves assisting with operational support for key service offerings and responding to inquiries about claims. The ideal candidate has experience in claims, strong communication skills, and the ability to work independently. Competitive pay and a diverse, inclusive work environment are offered.

Qualifications

• Minimum 1 year of claims experience.
• Strong written and verbal communication skills are required.
• Experience in the healthcare field is a plus.

Responsibilities

• Assist in the operational support of claims.
• Monitor and respond to inquiries related to claims processing.
• Serve as a SME for other departments.

Skills

Claims experience

Attention to detail

Organizational skills

Strong communication skills

Ability to work independently

Education

High school diploma or equivalent GED

Tools

Microsoft Office

Excel

Job description

Overview

Job Title: Claims Specialist Sr

The Claims Specialist is responsible for assisting in the ongoing operational support of Prime key service offerings. This position responds to inquiries from internal and external partners for the research and resolution of claim issues and serves as a subject matter expert for coworkers and other departments.

Responsibilities

• Work in Medicare, Commercial and Health Insurance Marketplace (HIM) lines of business to ensure strict adherence to unique guidelines and regulations for each.
• Monitor and respond to incoming inquiries related to specific processes or support systems (e.g., claim adjudication system). Escalate issues when appropriate.
• Partner with Prime's clients to produce and execute corrective measures found in key service offerings.
• Process authorizations to meet HIPAA/privacy and CMS requirements.
• Sort, research and process daily internal and external documents received by the mailroom.
• Assist with RxClaim release user acceptance testing and reporting.
• Serve as a subject matter expert (SME) resource for other departments.
• Other duties as assigned.

Minimum Qualifications

• High school diploma from an accredited institution or equivalent GED.
• 1 year of claims experience.
• Must be eligible to work in the United States without need for work visa or residency sponsorship.

Additional Qualifications

• Experience with Microsoft Office products.
• Strong written and verbal communication skills.
• Strong organizational skills.
• Ability to work independently.
• Strong attention to detail with ability to perform with a high degree of accuracy.
• Ability to prioritize and handle multiple tasks simultaneously.

Preferred Qualifications

• 2+ years of experience in claims, insurance, or healthcare.
• Extensive experience using Excel spreadsheets.

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Every employee must be able to perform the essential functions of the job, and reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $19.23 - $28.85 based on experience and skills.

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 proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives, including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

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

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [e-mail].