Claims Specialist

• Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing
• Research, analyze, and resolve rejected claims with Medicare D plans, third-party insurance companies, and state Medicaid plans
• Perform edits and/or reversals to obtain claim approval and maximize payer reimbursement
• Monitor and resolve at-risk revenue related to payer setup, billing, rebilling, and reversal processes
• Collaborate with the team to identify, document, communicate, and resolve payer and billing trends and issues
• Review and convert billing exception reports to ensure claims are billed to accurate financial plans
• Prepare and maintain processing reports and records
• Perform other assigned tasks

Pharmacy Claims Processor

• Investigate assigned casualty claims by collecting statements, physical evidence, and legal documentation
• Analyze and interpret policy coverage and determine liability and damages
• Negotiate claims settlements in accordance with company procedures and within authority limits
• Communicate claim status to all relevant stakeholders, including insureds and agents
• Maintain accurate documentation in company systems and adhere to regulatory and internal standards
• Participate in training and education programs to enhance claim-handling skills
• Travel as needed for onsite investigations or meetings

Claims Specialist jobs in Kentucky

Pharmacy Claims Processor

Casualty Claims Representative