Remote/Hybrid Insurance Resolution Specialist (Pharmacy Claims)

Pantherx Specialty LLC; Pittsburgh (Allegheny County); Hybrid; USD 45,000 - 60,000; Full time

Benefits offered by this job

Medical insurance

401K with employer matching

Paid time off

Dental and vision benefits

Employee Assistance Program

Job summary

PANTHERx Rare Pharmacy in Pittsburgh, PA, is hiring an Insurance Resolution Specialist (Mid Shift) to verify pharmacy and medical claims with speed and accuracy. This role acts as the liaison among patients, insurers, and government agencies to ensure correct billing and timely medication delivery.

The position requires a high school diploma and at least 2 years of claims processing experience, with proficiency in Cover My Meds, EDS systems, Excel, and Word. Hybrid work options are available.

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.
• Proficient with Cover My Meds, EDS billing systems, Excel, and Word.
• Experience in healthcare, especially mail order or specialty pharmacy, is preferred.
• Understanding of benefit verification and prior authorization processes.
• Experience with CPR+ is a plus.

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 in coordination with insurance providers.
• Processes patient information for copay cards and/or assistance programs.
• Discusses with patients a review of patient financial responsibility, and obtains patient consent and payment.
• Ensures proper shipment set up of prescriptions.
• Supports special projects.
• Other tasks as assigned.

Skills

Pharmacy claims

Benefit verification

Cover My Meds

EDS billing systems

Excel

Word

Communication

Multitasking

Education

High school diploma or GED

Tools

Cover My Meds (CMM)

EDS billing systems

Excel

Word

Job description

PANTHERx Rare Pharmacy in Pittsburgh, PA, is hiring an Insurance Resolution Specialist (Mid Shift) to verify pharmacy and medical claims with speed and accuracy. This role acts as the liaison among patients, insurers, and government agencies to ensure correct billing and timely medication delivery.

The position requires a high school diploma and at least 2 years of claims processing experience, with proficiency in Cover My Meds, EDS systems, Excel, and Word. Hybrid work options are available.