Lead Claims Processor, Government Programs

Prime Therapeutics; Bismarck (ND); On-site; USD 10,000 - 60,000; Full time

Job summary

A healthcare company in Bismarck, ND is seeking a Lead Claims Processor to manage claims and improve processing efficiency. Candidates should have a Bachelor's degree and over 5 years of experience in claims handling. Responsibilities include adjudicating claims and leading quality assurance efforts. A pay range of $21.15 - $31.73 based on experience is offered.

Benefits

Comprehensive benefits package

Qualifications

• 5+ years of experience in claims processing required.
• Combination of education and work experience may be considered.

Responsibilities

• Adjudicate or submit claims and adjustments as required.
• Implement and maintain claims processing programs and procedures.
• Verify claims adjudication for consistency and accuracy.

Skills

Ability to quickly use a 10-key machine

Education

Bachelor's Degree or equivalent experience

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

Lead Claims Processor, Government Programs

Job Description

Adjudicate or submit claims and adjustments as required. Track and trend performance of root cause analysis and provide additional training as needed. Resolve claims edits and suspended claims.

Responsibilities

• Adjudicate or submit claims and adjustments as required.
• Implementation and maintenance of claims processing programs and procedures
• Verify that claims are being adjudicated or submitted according to contracts in a consistent and accurate manner.
• Manage projects and administrative duties as required by business need.
• Lead and implement positive changes with a high level of quality and professionalism.
• Provide backup support to other team/group members in the performance of job
• Other duties as assigned

Education & Experience

• Education Level
• A Combination of Education and Work Experience May Be Considered.
• Bachelors
• Required
• Yes
• Yes
• Fields of Study
• Experience Level
• 5+ years
• Required
• Yes
• Details
• Claims

Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Additional Qualifications

• Ability to quickly use a 10-key machine

Physical Demands

• Must be able to remain in a stationary position 50% of the time. Must be able to "move or traverse"
• Must be able to constantly operate a computer and/or other office productivity equipment
• Must be able to hear and constantly communicate information and ideas. Must be able to exchange accurate information
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

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.

Potential pay for this position ranges from $21.15 - $31.73 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.

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

Prime Therapeutics LLCis 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 (including pregnancy), 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].

At Prime Therapeutics (Prime), we are a different kind of PBM. We’re reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference.

We know that people make all the difference. If you’re ready for a purpose-driven career and are passionate about simplifying health care, let’s build the future of pharmacy together.