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ConnectiveRx · 1 day ago

Claims Specialist

Whippany, NJ

Full-time

Onsite

Entry Level

$17.51/hr - $22.95/hr

1+ years exp

ConnectiveRx is dedicated to simplifying the prescription process for patients and pharmaceutical manufacturers. The Claims Specialist is responsible for processing medical claims, ensuring accuracy, and responding to inquiries while meeting productivity and quality standards.

Health CareHospital

Responsibilities

Verifies the accuracy and completeness of claim forms and attachments, such as EOBs, EOPs, SPPs, and pharmacy receipts. Information is entered into adjudication systems as required. Claims are paid or rejected based upon system adjudication and/or application of business rules external to the systems. Consult with the Team Lead or Supervisor for complex claims or clarification of business rules. Obtains missing information by calling or writing customers using standard scripts or form letters. Based on volume, may also process claims and/or answer phones

Refers to requests for escalation as needed and engages other internal areas such as Program Management, IT, and other Contact Center teams to resolve issues

Provide input and feedback to the Supervisor, Quality Management, and Training (among others) to improve processes, procedures, and training

Other projects and tasks as assigned

Qualification

Medical claims processingPharmacy benefits experienceEOBEOP knowledgeThird-Party systems experienceBilingual (English/Spanish)Communication skillsCustomer focusDetail orientedAdaptabilityProblem solving

Required

High School or GED required

1+ years in a health care or case management setting

Experience working in pharmacy benefits, health care insurance, and/or medical billing a must

Health care or pharmaceutical experience, particularly in a medical claims processing, billing provider, or insurance environment

Knowledge of EOB and EOP statements

Knowledge of Medical Claims processing/billing coding

Communication skills: Uses writing effectively to create documents, uses correct spelling, grammar, and punctuation; Ability to convey written and verbal information in easy-to-understand language

Customer Focus: High level of empathy and emotional intelligence; Focuses on the opportunity to service patients with a high level of empathy

Detail Oriented: Achieves thoroughness and accuracy when accomplishing a task

Adaptability: Adapts to a variety of situations easily and effectively navigates situations

Problem Solve; Thinks critically, and problem-solves issues to resolution