Claims Specialist

4 weeks ago

Taunton, Massachusetts, United States BrightSpring Health Services Full time
Claims Specialist Opportunity

We are seeking a 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 Responsibilities:

  • Manage and resolve rejected pharmacy claims to ensure maximum payer reimbursement and timely billing.
  • Research, analyze, and resolve rejected claims by working with national Medicare D plans, third-party insurance companies, and state Medicaid plans.
  • Ensure approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement.
  • Monitor and resolve at-risk revenue associated with payer set up, billing, rebilling, and reversal processes.
  • Work as a team to identify, document, communicate, and resolve payer/billing trends and issues.

Requirements:

  • High School Diploma or GED.
  • Customer service experience.
  • Ability to retain a large amount of information and apply that knowledge to related situations.
  • Basic math aptitude and Microsoft Office Suite skills.

What We Offer:

  • Daily pay.
  • Flexible schedules.
  • Competitive pay with shift differentials.
  • Health, dental, vision, and life insurance.
  • Company-paid disability insurance.
  • Tuition assistance and reimbursement.
  • Employee discount program.
  • 401(k) plan.
  • Paid time off.

At BrightSpring Health Services, we offer a non-retail, closed-door pharmacy environment, allowing you to focus on what truly matters—delivering exceptional care and service. If you're passionate about service excellence and are looking for a role where you can grow and make a difference, we'd love to have you on our team.

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