Pharmacy Claims Analyst - Flexible Hours(Provider Services)

Alberta Blue Cross; Edmonton; On-site; CAD 42,000 - 64,000; Full time

Job summary

Alberta Blue Cross is seeking an enthusiastic individual to join our Provider Services & Claims Administration team, working in a flexible work style arrangement. Under the guidance of a Team Lead, you will handle day-to-day processing of manual pharmacy claims and complex inquiries with accuracy and efficiency.

You will assess claim adjudication results, conduct QA checks, educate providers on submissions and reversals, and contribute to reporting while maintaining our standard of excellent

Qualifications

• Deliver superior customer service and build effective relationships.
• Strong problem-solving abilities and attention to detail; use good judgment and accuracy.
• Excellent organizational and time management skills to prioritize tasks and meet timelines.

Responsibilities

• Process manual pharmacy claims, including high-cost drug claims, accurately and timely.
• Perform quality assurance checks on claim adjudication results and adjust claims when necessary.
• Educate pharmacy providers on claims submissions and reversals, including collection of monies.
• Perform system testing.
• Research and analyze information to resolve complex inquiries or unique situations.
• Track and complete reporting on work initiatives.
• Monitor production to ensure output and timelines are met.
• Suggest workflow improvements to increase efficiency and innovation.
• Be willing to occasionally work flexible hours.

Skills

Customer service

Problem solving

Attention to detail

Time management

Adaptability

Accountability

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Access

Job description

Alberta Blue Cross is seeking an enthusiastic individual to join our Provider Services & Claims Administration team, working in a flexible work style arrangement. Under the guidance of a Team Lead, you will handle day-to-day processing of manual pharmacy claims and complex inquiries with accuracy and efficiency.

You will assess claim adjudication results, conduct QA checks, educate providers on submissions and reversals, and contribute to reporting while maintaining our standard of excellent