Remote Pharmacy Claims Specialist

PharMerica; Blanco (TX); On-site; USD 42,000 - 58,000; Full time

Benefits offered by this job

DailyPay

Flexible Schedules

Competitive Pay with Shift Differenti

Job summary

PharMerica is seeking a Claims Specialist for a 100% remote role. You will manage and resolve rejected pharmacy claims to ensure clients receive appropriate reimbursement, while collaborating with Medicare D plans, insurers, and Medicaid programs.

The ideal candidate has customer service experience, strong attention to detail, and knowledge of claims processes. This role offers comprehensive benefits and a non-retail, closed-door environment designed for focus and accuracy.

Qualifications

• Required: High School Diploma or GED.
• Desired: Associate’s or Bachelor’s Degree.
• Required: Customer Service experience.
• Desired: Pharmacy Technician experience.

Responsibilities

• Manage and identify rejected pharmacy claims to maximize reimbursement.
• Research, analyze and resolve rejected claims with national Medicare D plans and state Medicaid.
• Perform edits and reversals to ensure claims are approved and reimbursed.
• Monitor and resolve at-risk revenue from payer setup and billing processes.
• Collaborate to identify payer and billing trends and issues.
• Review billing exception reports for accurate billing.
• Prepare and maintain processing reports and records.
• Perform other tasks as assigned.

Skills

Customer service experience

Microsoft Office

Attention to detail

Data entry

Education

High School Diploma or GED

Associate’s or Bachelor’s Degree (desired)

Tools

Medicare D claims systems

Job description

PharMerica is seeking a Claims Specialist for a 100% remote role. You will manage and resolve rejected pharmacy claims to ensure clients receive appropriate reimbursement, while collaborating with Medicare D plans, insurers, and Medicaid programs.

The ideal candidate has customer service experience, strong attention to detail, and knowledge of claims processes. This role offers comprehensive benefits and a non-retail, closed-door environment designed for focus and accuracy.