Claims Specialist

ConnectiveRx

. Process medical claims received from patients and/or HCPs across a broad product suite .

Posted 10/7/2026full-timePittsburgh • Pennsylvania • United StatesJunior💰 $16 - $21 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical claims processing and billing, with a strong focus on accuracy and thoroughness. Proficient in using third-party systems and effectively communicating with patients and healthcare professionals.

Highest-signal resume keywords

Medical Claims ProcessingPharmacy Benefits ExperienceEOB and EOP KnowledgeThird-Party Systems ExperienceFluent in English/Spanish

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical Billing CodingClaims AdjudicationData EntryQuality Standards ComplianceHigh-Volume Processing

Soft Skills

EmpathyEmotional IntelligenceCritical ThinkingProblem SolvingEffective Communication

Tools & Technologies

ConnectiveRxSelectRxPro-CareFSV

Certifications & Qualifications

High School Diploma or GED

Industry Keywords

Health Care InsuranceMedical ClaimsPharmaceutical ExperienceCase ManagementEOBsEOPs

About the role

Key responsibilities & impact

Process medical claims received from patients and/or HCPs across a broad product suite
Meet or exceed productivity and quality standards
Use ConnectiveRx and third-party systems to process claims and respond to inquiries from patients, physicians, pharmacies, and clients
Verify the accuracy and completeness of claim forms and attachments, including EOBs, EOPs, SPPs, and pharmacy receipts
Enter information into adjudication systems
Pay or reject claims based on system adjudication and/or business rules
Consult with the Team Lead or Supervisor regarding complex claims or business-rule clarification
Obtain missing information by calling or writing customers using standard scripts or form letters
Process claims and/or answer phones based on volume
Refer requests for escalation as needed
Engage Program Management, IT, and other Contact Center teams to resolve issues
Provide input and feedback to the Supervisor, Quality Management, and Training to improve processes, procedures, and training
Complete other projects and tasks as assigned

Requirements

What you’ll need

High School or GED required
1+ years in a health care or case management setting
Experience working in pharmacy benefits, health care insurance, and/or medical billing a must
Health care or pharmaceutical experience, particularly in a medical claims processing, billing provider, or insurance environment
Knowledge of EOB and EOP statements
Prior experience in a high-volume processing setting (i.e., doctor’s office, claims processing department, etc.) a plus.
Will be trained to support programs, clients, and/or job functions as appropriate
Experience with Third-Party systems (SelectRx, Pro-Care, FSV) (preferred)
Fluent in English/Spanish (a plus).
Knowledge of Medical Claims processing/billing coding
Uses writing effectively to create documents, uses correct spelling, grammar, and punctuation
Ability to convey written and verbal information in easy-to-understand language
High level of empathy and emotional intelligence
Focuses on the opportunity to service patients with a high level of empathy
Achieves thoroughness and accuracy when accomplishing a task
Adapts to a variety of situations easily and effectively navigates situations
Thinks critically, and problem-solves issues to resolution