Superior data entry proficiency is expected in order to provide accurate and timely processing of claims submitted by member, pharmacy or appropriate agency.
Moderate knowledge of drugs and drug terminology used daily.
Process claims according to client specific guidelines while identifying claims requiring exception handling.
Navigate daily through several platforms to research and accurately finalize claim submissions. Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues.
Adhere to strict HIPAA regulations especially when communicating to others outside of the client
Prioritize and coordinate influx of daily workload for claims processing, returned mail and out-going correspondence and e-mails to assure required turnaround time is met.
Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.
Analyze claims for potential fraud by member or pharmacy.
May be required to work on special projects for claims team.
High school graduate / GED
1-3 years of experience processing claims in a Healthcare Environment
Must have the reimbursement experience.
Experienced in benefits verifications, submitted test claims, completed or reviewed prior authorizations, have PBM experience
Strong data entry and 10-key skills
Retail pharmacy, customer service experience helpful but not required
PC and MS Office literate
Strong attention to detail
Excellent retention and judgment ability
Proficient written and oral communication skills
Ability to work in fast-pace, production environment
Kelly Services is an American office staffing company that operates globally. The company places employees at all levels in various sectors including the financial services, information technology, and law industries.
Role: Healthcare Claims/Reimbursement Specialist
Location: Lake Mary,
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