Pharmacy Claims Representative 2 – Patient Financial Services

CenterWell Senior Primary Care

. Adjudicate pharmacy claims and process pharmacy claims for payment .

Posted 10/16/2026full-timeRemote • United StatesJunior💰 $40,000 - $52,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in pharmacy claims adjudication and customer service, with a strong ability to analyze data and provide financial support while ensuring compliance with HIPAA regulations.

Highest-signal resume keywords

Pharmacy Claims AdjudicationCustomer Service ExperienceMicrosoft Office ProficiencyData AnalysisHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pharmacy Claims ProcessingData AnalysisInsurance VerificationPatient Assistance ProgramsCase Documentation

Soft Skills

Relationship BuildingCommunication SkillsProblem-Solving

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft OutlookWindows-Based Systems

Industry Keywords

Customer SupportFinancial SupportCo-Pay AnalysisDeductible AnalysisInbound and Outbound Calls

About the role

Key responsibilities & impact

Adjudicate pharmacy claims and process pharmacy claims for payment
Analyze and answer inquiries regarding pharmacy claims adjudication, including payment method, co-pay or deductible amounts, and reasons for denial
Analyze data and provide financial support
Develop relationships with foundations and manufacturers
Provide internal customer support for the entire Pharmacy
Source patient assistance programs and/or foundations to help patients meet out-of-pocket responsibility
Take inbound and make outbound calls related to patient assistance programs, billing inquiries, and insurance verification
Provide internal and external customer service
Document case files with complete notes
Complete special projects with varied and complex components

Requirements

What you’ll need

1 or more years of customer service experience handling both incoming and outgoing phone calls in a professional setting
Comprehensive knowledge of Microsoft Products including Word, Excel and Outlook
Intermediate to High level of Windows Based system navigation
Ability to work an 8 hour shift between 8am and 8pm EST Monday-Friday
Overtime may be required during peak season
Internet service with minimum 25 Mbps download and 10 Mbps upload speed
Dedicated workspace without ongoing interruptions to protect member PHI / HIPAA information

Benefits

Comp & perks

Medical, dental and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Other wellness and healthcare opportunities
Remote work arrangement
Occasional travel to Humana offices for training or meetings