Pharmacy Claims Representative – Patient Financial Services | Humana | Springdale, OH

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  • United States, Springdale, OH View on Map
  • Post Date : November 19, 2020
  • Apply Before : December 19, 2020
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Job Description

The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Use your business knowledge to help analyze data and provide financial support. Humana is seeking a Patient Finance Specialist that will work on the behalf of Humana customers, develop relationships with foundations and manufacturers, and provide internal customer support for the entire Pharmacy.


The Pharmacy Claims Representative 2 analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Patient Finance Specialist detailed description:

  • Source Patient Assistance program and/or foundation to assist patients in meeting Out Of Pocket responsibility
  • Take inbound and make outbound calls related to Patient Assistant Program, billing inquiries, and insurance verification
  • Provide customer service (internal/external)
  • Documenting case files with complete notes on work
  • Complete special projects with varied and complex components as needed

Required Qualifications

  • High school diploma or GED
  • 1 to 2 years of customer service experience
  • Previous experience working phones on an incoming and outgoing basis
  • Comprehensive knowledge of Microsoft Products including Word, Excel and Outlook
  • Intermediate to High level of Windows Based system navigation
  • Must be able to work a shift between 8am and 8pm EST Monday-Friday

Role Desirables

  • Bachelor’s Degree in Finance, Accounting or a related field
  • Previous Healthcare and/or Mail Order Pharmacy experience
  • Fluency in Spanish

Scheduled Weekly Hours


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