Specialty & Home Delivery Program Claims Analyst - Remote

Prime Therapeutics; Raleigh (NC); Remote; USD 59,000 - 94,000; Full time

Job summary

A healthcare solutions provider in Raleigh seeks a Specialty & Home Delivery Program Claims Analyst. The role involves monitoring claims, serving as a subject matter expert, and partnering with clients to problem solve. Qualified candidates should have a Bachelor’s degree and 2 years of claims processing experience. The estimated salary ranges from $59,000 to $94,000 based on experience and skills.

Qualifications

• 2 years of work experience in claims processing or project lifecycle.
• Eligibility to work in the United States without need for work visa.

Responsibilities

• Represent Strategic Partnerships as SME on internal and external projects.
• Perform daily claims monitoring and data validation activities.
• Research and analyze information to validate errors and financial impact.

Skills

Claims research experience

PBM industry knowledge

Experience working with RxClaim

Education

Bachelor's degree in IT, Business, Science or related area

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.

Overview

Specialty & Home Delivery Program Claims Analyst - Remote. The Specialist is responsible for serving as a subject matter expert on Home Delivery and Specialty pharmacy partners and Pharmacy Match product, which may include implementations, projects, claims & performance guarantee monitoring, and testing. This position works with internal and external clients and serves as an escalation and mentoring resource for inquiries and issues.

Responsibilities

• Represent Strategic Partnerships as SME on internal and external projects, participating in all relevant functions on project lifecycle as assigned
• Perform daily claims monitoring and data validation activities
• Research and analyze information by employing analytics and data science techniques to research and validate errors, isolate impacted claims, reprocess claims, and determine financial impact to members, health plans and/or pharmacies; translate data into usable internal and/or client facing reports
• Respond to inquiries related to specific job function process or support systems and provide documentation and tracking to resolution
• Partner with Prime's Clients to identify, problem solve, and execute corrective measures
• Provide backup support to various roles within department with ability to serve as short-term stand-in for each position, when necessary
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in IT, Business, Science or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
• 2 years of work experience in claims processing or project lifecycle, or related roles in the healthcare or PBM industry
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Preferred Qualifications

• Claims research experience
• PBM industry knowledge
• Experience working with RxClaim

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.

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the Benefits at a glance button for more detail.

Prime Therapeutics LLC is 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 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].