Pharmacy Claims & Provider Services Analyst

Alberta Blue Cross; Edmonton; Hybrid; CAD 42,000 - 68,000; Full time

Job summary

Alberta Blue Cross® in Edmonton is seeking an enthusiastic individual to join our Provider Services & Claims Administration team, handling manual pharmacy claims and complex inquiries with accuracy and timeliness.

Under supervision, you will perform QA on adjudication results, assist providers with submissions/reversals, and participate in system testing and reporting while maintaining superior customer service.

Qualifications

• Strong customer service orientation and ability to build effective relationships with stakeholders.
• Excellent problem-solving abilities and high attention to detail.
• Excellent organizational and time management skills with the ability to prioritize tasks.
• Adaptability and willingness to adjust to changing priorities.
• Ability to work with minimal supervision and accountability.

Responsibilities

• Process manual pharmacy claims, including high-cost drug claims, ensuring adjudication accuracy and timeliness.
• Perform quality assurance checks on claim adjudication results and complete necessary adjustments.
• Educate and assist pharmacy providers with claims submissions and reversals, including collection of monies.
• Conduct system testing and track reporting on work initiatives.
• Research and analyze information to resolve complex inquiries or unique situations.
• Monitor production and ensure timelines and output meet expectations.
• Suggest workflow improvements to increase efficiency and innovation.
• Be available for occasional flexible hours.

Job description

Alberta Blue Cross® in Edmonton is seeking an enthusiastic individual to join our Provider Services & Claims Administration team, handling manual pharmacy claims and complex inquiries with accuracy and timeliness.

Under supervision, you will perform QA on adjudication results, assist providers with submissions/reversals, and participate in system testing and reporting while maintaining superior customer service.