Offer summary

Qualifications:

Bachelor's degree or equivalent combination of education and work experience., 5+ years of experience in claims processing., Ability to quickly use a 10-key machine is preferred., Must be eligible to work in the United States without the need for visa sponsorship..

Key responsibilities:

Adjudicate or submit claims and adjustments as required.

Implement and maintain claims processing programs and procedures.

Verify claims are adjudicated according to contracts accurately.

Manage projects and provide backup support to team members.

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.

Job Posting Title

Lead Claims Processor, Government Programs

Job Description

Adjudicate or submit claims and adjustments as required. Track and trend performance of root cause analysis and provide additional training as needed. Resolve claims edits and suspended claims.

Responsibilities

Adjudicate or submit claims and adjustments as required.
Implementation and maintenance of claims processing programs and procedures
Verify that claims are being adjudicated or submitted according to contracts in a consistent and accurate manner.
Manage projects and administrative duties as required by business need.
Lead and implement positive changes with a high level of quality and professionalism.
Provide backup support to other team/group members in the performance of job
Other duties as assigned

Education & Experience

Education Level
- A Combination of Education and Work Experience May Be Considered.
- Bachelors
Required
- Yes
- Yes
Fields of Study

Experience Level
- 5+ years
Required
- Yes
Details
- Claims

Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Additional Qualifications

Ability to quickly use a 10-key machine

Preferred Qualifications

Physical Demands

Must be able to remain in a stationary position 50% of the time. Must be able to "move or traverse"
Must be able to constantly operate a computer and/or other office productivity equipment
Must be able to hear and constantly communicate information and ideas. Must be able to exchange accurate information
Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

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.

Potential pay for this position ranges from $21.15 - $31.73 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 proud to be 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 (pregnancy, sexual orientation, and gender identity), 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 LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

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