Pharmacy Claims Manager

2 days ago


Tampa, Florida, United States PrudentRx, LLC Full time
PrudentRx, LLC is a leading healthcare company seeking a highly skilled Claims Manager to join our team. This is a full-time position that can be performed remotely with the ability to work from home. The salary for this role is estimated to be around $90,000 per year.

The successful candidate will oversee the entire pharmacy claims review process to ensure accuracy, efficiency, and compliance. They will monitor and resolve discrepancies, including coding, eligibility, and pharmacy errors. Additionally, they will lead, mentor, and develop a team of claims specialists, set performance targets, and monitor team metrics to ensure operational excellence.

To qualify for this role, you should have at least 3 years of experience in pharmacy claims, healthcare claims management, or a similar field. Direct management experience is also required, preferably with a team. You should have a strong understanding of pharmacy benefit management processes, formularies, and claim adjudication systems. Experience with Medicare, Medicaid, and commercial insurance plans is preferred.

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