Claims Specialist Sr

Prime Therapeutics; Pierre (SD); On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare services provider is seeking a Claims Specialist Sr to support the operational functions and resolve claim issues. The ideal candidate will have at least 1 year of claims experience and strong communication skills. This role involves adhering to guidelines in Medicare and other lines of business while ensuring compliance with legal and regulatory requirements. The position offers a competitive salary range based on skills and experience.

Benefits

Healthcare benefits

Flexible work hours

Employee assistance programs

Qualifications

• 1 year of claims experience.
• Must be eligible to work in the United States without need for visa sponsorship.
• Strong written and verbal communication skills.

Responsibilities

• Assist in operational support of key service offerings.
• Respond to inquiries related to claim issues.
• Monitor and respond to incoming inquiries.

Skills

Communication skills

Organizational skills

Attention to detail

Education

High school diploma or equivalent GED

Tools

Microsoft Office products

Excel spreadsheets

Job description

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Claims Specialist Sr

Job Description

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

Responsibilities

• Work in Medicare, Commercial and Health Insurance Marketplace (HIM) integrity lines of business to ensure strict adherence to unique guidelines and regulations for each
• Monitor and respond appropriately to incoming inquiries related to specific process 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
• Sorts, researches and processes 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 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 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, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, 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 (https://www.primetherapeutics.com/benefits) 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.

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].