Claim Specialist - Visa GC/Citizen Division Pharmaceutical

Overview:


We are seeking an experienced Claim Specialist to join our team in the Visa GC/Citizen Division Pharmaceutical department. As a Claim Specialist, you will be responsible for verifying member submitted claims forms, ensuring accurate and timely processing of claims, and communicating with internal departments, members, pharmacies, and agencies to resolve claim issues.
Responsibilities:

1. Verify member submitted claims forms, member's eligibility, and pharmacy information is complete and accurate, updating system information as needed (40%). 2. Process claims according to client-specific guidelines, identifying claims requiring exception handling (15%). 3. Research to define values for missing information not submitted with claim but required for processing (15%). 4. Initiate correspondence to members, pharmacies, or other internal departments for missing information, claim denials, or other claim issues (15%). 5. Evaluate claim submissions, ensure all required information is present, and determine what action should be taken (5%). 6. Identify exception handling and process per client requirements, monitoring system to ensure client-specific documentation is current and system editing is operating appropriately (5%). 7. Perform other miscellaneous duties as assigned (5%).
Qualifications:

* High school diploma or equivalent required, some college or technical training preferred

* Two years' experience in P.B.M. environment is helpful but not required

* Strong data entry, 10-key skills, general PC skills, and MS Office experience

* Strong attention to detail, excellent retention and judgment ability, proficient written and oral communication skills, and ability to work in a fast-paced production environment

Benefits:

* Competitive hourly rate of $16.00

* 5-month contract with potential for extension

* Flexible work schedule (Monday - Friday, 9:00 AM - 6:00 PM)

* Opportunities for professional growth and development in a dynamic and fast-paced environment