Hybrid Insurance Resolution & Claims Specialist

Pantherx Specialty LLC; Pittsburgh (Allegheny County); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health insurance

401K with employer matching

Paid time off

Flexible scheduling

Job summary

PANTHERx Rare Pharmacy is seeking an Insurance Resolution Specialist in Pittsburgh, PA. This role verifies patient pharmacy and medical claims, liaises with patients, insurers, and government agencies to ensure timely, accurate billing and medication delivery.

The position is full-time, hybrid/remote eligible, and located in a healthcare environment focused on rare diseases. A GED or high school diploma and 2 years of claims experience are required, with proficiency in CMM, EDS, Excel, and Word.

Qualifications

• High school diploma or GED is required.
• Minimum 2 years’ experience processing pharmacy claims and benefit investigation.
• Strong written and verbal communication skills.
• Ability to multitask and manage competing priorities.

Responsibilities

• Verifies all benefit information needed to process a claim under pharmacy or medical coverage.
• Processes pharmacy claims on the patient’s behalf through a pharmacy benefit system.
• Verifies medical benefits accurately on patient’s behalf.
• Obtains authorizations & overrides as needed with insurance providers.
• Processes patient information for copay cards and/or assistance programs.
• Discusses with patients a review of patient financial responsibility and obtains consent and payment.
• Ensures proper shipment setup of prescriptions.
• Supports special projects and other tasks as assigned.

Skills

Communication skills

Multitasking

Education

High school diploma or GED

Tools

Cover My Meds (CMM)

EDS billing systems

Excel

Word

Job description

PANTHERx Rare Pharmacy is seeking an Insurance Resolution Specialist in Pittsburgh, PA. This role verifies patient pharmacy and medical claims, liaises with patients, insurers, and government agencies to ensure timely, accurate billing and medication delivery.

The position is full-time, hybrid/remote eligible, and located in a healthcare environment focused on rare diseases. A GED or high school diploma and 2 years of claims experience are required, with proficiency in CMM, EDS, Excel, and Word.