Pharmaceutical Claim Specialist

3 weeks ago


Oviedo, Florida, United States Elite Care Rx Full time
About the Role

We're seeking a skilled Medical Claims Processor to join our team at Elite Care Rx. As a key member of our claims department, you'll be responsible for utilizing A/R reports to identify past-due accounts and communicating with insurance carriers, adjusters, PBMs, and TPAs to verify claim information and resolve payment issues.

You'll receive payment on delinquent orders by correcting and resubmitting claims with billing errors, drafting formal appeals to overturn denials, and maintaining clear communication with TPAs, bill review vendors, and insurance adjusters.

Responsibilities include organizing daily workflow, escalating accounts and unpaid prescriptions as necessary, and keeping detailed notes in our billing software system advising of all communications and actions taken to resolve accounts.

Qualifications and Education Requirements:

  • High School Diploma; College degree preferred
  • Previous experience in medical billing or claim processing
  • Effective in utilizing Microsoft Office and other software programs
  • Excellent written and verbal communication skills
  • Ability to prioritize and multitask
  • Strong math and analytical skills

Preferred Skills:

  • Background and experience in pharmacy and medical terminology a plus, but not required
  • Working knowledge of an EOB and HCFA
  • Worker's compensation and/or personal injury claim experience is a plus

Starting wages negotiable based on experience and quality of interview.



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