Claims Processing Specialist

2 weeks ago


Taunton, Massachusetts, United States BrightSpring Health Services Full time

Company Overview

BrightSpring Health Services

Position Summary

As a Claims Processing Specialist, you will play a vital role in our third-party claims operations. This position offers a unique opportunity for individuals transitioning from retail pharmacy settings to a professional office environment, where you will gain valuable experience in claims management, billing, and insurance processing.

Work Environment

This is a remote position, allowing you to work from anywhere within the continental United States. We encourage applicants from various regions, with a preference for candidates in specific areas.

Schedule

Monday to Friday, 9 AM - 5:30 PM CST

Benefits

We offer a comprehensive benefits package, including:

  • DailyPay
  • Flexible work schedules
  • Competitive compensation
  • Shift differentials
  • Health, dental, vision, and life insurance
  • Company-paid short-term and long-term disability
  • Tuition assistance
  • Employee discount programs
  • 401(k) retirement plan
  • Paid time off
  • Tuition reimbursement

Role Responsibilities

The Claims Processing Specialist will:

  • Manage and analyze a portfolio of rejected pharmacy claims to maximize reimbursement and ensure timely billing.
  • Investigate and resolve rejected claims by collaborating with national Medicare D plans, third-party insurers, and state Medicaid programs.
  • Ensure claim approvals through necessary edits and reversals to optimize reimbursement.
  • Monitor revenue risks related to payer setups, billing, rebilling, and reversal processes.
  • Collaborate with team members to identify and address billing trends and issues.
  • Review billing exception reports to ensure accurate financial plan billing.
  • Prepare and maintain processing reports and records.
  • Perform additional tasks as assigned.

Qualifications

Education:

  • Required: High School Diploma or GED
  • Preferred: Associate's or Bachelor's Degree

Experience:

  • Required: Customer service experience
  • Preferred: Up to one year of related experience, particularly in pharmacy settings.

Skills:

  • Required: Strong retention of information and application to relevant situations, ability to thrive in a fast-paced environment, basic math skills, proficiency in Microsoft Office Suite.
  • Preferred: Familiarity with trends and regulations in the insurance industry.

Licenses/Certifications:

  • Preferred: Pharmacy technician certification, though not mandatory.

About BrightSpring Health Services

BrightSpring Health Services is a leading provider of pharmacy solutions, delivering value beyond medication. We are dedicated to serving long-term care facilities, skilled nursing homes, public health organizations, and post-acute care providers. Our organization is committed to employee development, fostering a positive company culture, and offering numerous opportunities for career advancement.

Salary Range

USD $19.00 - $26.00 per hour



  • Taunton, Massachusetts, United States PharMerica Full time

    Company Overview: PharMerica is a leading provider of pharmacy solutions, dedicated to delivering exceptional care and service to our long-term care and senior living clients.Position Summary: Our Claims Processing Specialists play a vital role in managing our 3rd Party Claims operations. This position is ideal for individuals transitioning from retail...

  • Claims Specialist

    5 days ago


    Taunton, Massachusetts, United States BrightSpring Health Services Full time

    About the RoleWe are seeking a highly skilled Claims Specialist to join our team at BrightSpring Health Services. As a Claims Specialist, you will play a critical role in ensuring our clients receive the pharmaceutical support they need.Key ResponsibilitiesManage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and...

  • Claims Specialist

    3 days ago


    Taunton, Massachusetts, United States BrightSpring Health Services Full time

    About the RoleWe are seeking a highly skilled Claims Specialist - 3rd Party to join our team at BrightSpring Health Services. As a Claims Specialist, you will play a critical role in ensuring maximum payer reimbursement and timely billing to eliminate financial risks.Key ResponsibilitiesManage and identify a portfolio of rejected pharmacy claims to ensure...

  • Claims Specialist

    6 days ago


    Taunton, Massachusetts, United States BrightSpring Health Services Full time

    About the RoleWe are seeking a highly skilled Claims Specialist - 3rd Party to join our team at BrightSpring Health Services. As a Claims Specialist, you will play a critical role in ensuring maximum payer reimbursement and timely billing to eliminate financial risks.Key ResponsibilitiesManage and identify a portfolio of rejected pharmacy claims to ensure...

  • Claims Specialist

    9 hours ago


    Taunton, Massachusetts, United States Amerita Full time

    About the RoleAmerita is seeking a highly skilled Claims Specialist - 3rd Party to join our team. As a Claims Specialist, you will play a critical role in ensuring maximum payer reimbursement and timely billing to eliminate financial risks.Key ResponsibilitiesManage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement...


  • Taunton, Massachusetts, United States HealthCare Support Full time

    Job OverviewHealthCare Support is currently seeking a Pharmacy Order Processing Specialist to join our dedicated team.Key Responsibilities:Efficiently manage, interpret, and enter medication orders into the pharmacy's computerized system while adhering to accuracy and productivity benchmarks.Conduct drug calculations, including basic math conversions (e.g.,...


  • Taunton, Massachusetts, United States HealthCare Support Full time

    Position Overview:HealthCare Support is currently seeking a dedicated Order Entry Technician to join our team. This role is essential in ensuring the accurate processing of medication orders in a fast-paced environment.Key Responsibilities:Efficiently triage, interpret, and input medication orders into the computerized order management system while adhering...


  • Taunton, Massachusetts, United States HealthCare Support Full time

    Order Entry Pharmacy Technician HealthCare Support is actively seeking a Order Entry Pharmacy Technician to fill an opening. Key Responsibilities:Accurately triage, interpret, and input medication orders into the computerized system while adhering to pharmacy productivity and accuracy standards. Regularly audit entries against documentation and make...


  • Taunton, Massachusetts, United States HealthCare Support Full time

    Order Entry Pharmacy Technician HealthCare Support is currently seeking a Order Entry Pharmacy Technician to fill a vital role. Key Responsibilities:Efficiently triage, interpret, and input medication orders into the computerized system while adhering to the pharmacy's accuracy and productivity benchmarks. Regularly audit entries against documentation and...


  • Taunton, Massachusetts, United States US1970 Prysmian Group Specialty Cables, LLC Full time

    Job SummaryThe Process Engineer will be responsible for planning and directing process development and maintenance of manufacturing specifications and standards. This role will also involve determining equipment, tooling, and processes required for manufacturing specialty copper and fiber optic cables.Key ResponsibilitiesDevelop and improve overall...


  • Taunton, Massachusetts, United States Prysmian Group Full time

    About Prysmian GroupPrysmian Group stands as a global leader in the energy and telecommunications cable systems sector. With a commitment to innovation and excellence, we produce extensive lengths of underground and submarine cables designed for effective power transmission and distribution.Role OverviewThe Process Engineer will play a crucial role in...


  • Taunton, Massachusetts, United States Prysmian Group Full time

    Prysmian Group stands as the global leader in the energy and telecommunications cable systems sector. Each year, we produce extensive lengths of underground and submarine cables and systems for power transmission and distribution, alongside medium and low voltage cables for construction and infrastructure. Our offerings also encompass a wide array of optical...


  • Taunton, Massachusetts, United States Prysmian Group Full time

    Prysmian Group stands as the global frontrunner in the energy and telecommunications cable systems sector. Annually, we produce extensive lengths of underground and submarine cables and systems designed for power transmission and distribution, alongside medium and low voltage cables tailored for construction and infrastructure projects. Our offerings also...


  • Taunton, Massachusetts, United States Prysmian Group Full time

    Prysmian Group stands as the global frontrunner in the energy and telecommunications cable systems sector. Annually, we produce extensive lengths of underground and submarine cables and systems dedicated to power transmission and distribution, alongside medium and low voltage cables tailored for construction and infrastructure applications. Our offerings...


  • Taunton, Massachusetts, United States Prysmian Group Full time

    Prysmian Group stands as the global leader in the energy and telecommunications cable systems sector. Each year, we produce extensive lengths of underground and submarine cables and systems for power transmission and distribution, alongside medium and low voltage cables tailored for construction and infrastructure projects. Our offerings also encompass a...

  • Pharmacy Technician

    6 days ago


    Taunton, Massachusetts, United States PharMerica Full time

    About PharMericaPharMerica is a leading provider of pharmacy services to senior living communities, skilled nursing facilities, and post-acute care organizations.Job SummaryWe are seeking a highly skilled Pharmacy Technician to join our team. As a Pharmacy Technician, you will play a critical role in ensuring the accuracy and efficiency of our medication...


  • Taunton, Massachusetts, United States HealthCare Support Full time

    Job SummaryHealthCare Support is seeking a skilled Pharmacy Order Entry Technician to join our team. As a Pharmacy Order Entry Technician, you will play a critical role in ensuring the accuracy and efficiency of medication orders.Key ResponsibilitiesTriage and interpret medication orders, accurately inputting them into our computerized system.Audit input...


  • Taunton, Massachusetts, United States IASIS Healthcare Full time

    Position OverviewThe Patient Service Specialist I plays a vital role within the administrative team, executing essential daily tasks to ensure efficient operations in the healthcare practice.Key ResponsibilitiesManage incoming calls, directing them appropriately and ensuring messages are conveyed to the relevant physician or staff member.Provide callers with...


  • Taunton, Massachusetts, United States SERVPRO of FJM Enterprises, Inc.ABOJ, LLCJDM Enterprises, Inc Full time

    We are seeking a detail-oriented professional to enhance our operationsBenefits:401(k) planComprehensive health coveragePaid leaveOpportunities for training and developmentOur expanding company is in search of a precise and organized individual capable of managing job file coordination tasks effectively. Candidates with backgrounds in claims processing,...


  • Taunton, Massachusetts, United States SERVPRO of FJM Enterprises, Inc.ABOJ, LLCJDM Enterprises, Inc Full time

    We are seeking a detail-oriented professional to enhance our operationsBenefits:401(k) planComprehensive health coveragePaid leaveOpportunities for training and professional growthOur expanding organization is in search of a precise and dedicated individual who can efficiently manage job file coordination responsibilities. Candidates with backgrounds in...