Claims Specialist Sr – Remote (Entry Level/No Degree RQD) Prime Therapeutics

Job Posting Title

Claims Specialist Sr

Job Description

The Claims Specialist is responsible for assisting in the ongoing operational support of Prime key service offerings. This position is responsible for responding to inquiries from internal and external partners for the research of and resolution of claim issues. Additionally, this position serves as a subject matter expert resource for coworkers and other departments.

Responsibilities

  • Work in Medicare, Commercial and Health Insurance Marketplace (HIM) integrity lines of business to ensure strict adherence to unique guidelines and regulations for each
  • Monitor and respond appropriately to incoming inquiries related to specific process or support systems (e.g. claim adjudication system). Escalate issues when appropriate
  • Partner with Prime’s clients to produce and execute corrective measures found in key service offerings
  • Process authorizations to meet HIPAA/privacy and CMS requirements
  • Sorts, researches and processes daily internal and external documents received by the mailroom
  • Assist with RxClaim Release user acceptance testing and reporting
  • Serve as a subject matter expert (SME) resource for other departments
  • Other duties as assigned

Minimum Qualifications

  • High school diploma from accredited institution or equivalent GED
  • 1 year of claims experience
  • Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

  • Experience with Microsoft Office products
  • Strong written and verbal communication skills
  • Strong organizational skills
  • Ability to work independently
  • Strong attention to detail with ability to perform with high degree of accuracy
  • Ability to prioritize and handle multiple tasks simultaneously

Preferred Qualifications

  • 2+ years of experience in claims, insurance, or healthcare
  • Extensive experience using Excel spreadsheets

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.

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $19.23 – $28.85 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, review the 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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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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