PrudentRx is seeking YOU! This role is ideal for a detail-oriented professional who thrives in a structured and predictable work environment and remains calm and focused while verifying and validating data from reliable sources.

The successful candidate demonstrates sound judgment, takes a thoughtful approach to decision-making, and minimizes risk through strict adherence to established processes and procedures. This position plays a critical role in ensuring client and member data is processed accurately, efficiently, and securely throughout the entire implementation lifecycle.

As a key contributor, the Claims Specialist will consistently uphold PrudentRx’s core values of accountability, dependability, professionalism, and service excellence.
 

Position Details

• Minimum 1 year employment with PrudentRx
• In good standing and can not be on corrective action or performance improvement plan

Responsibilities 

• Review and analyze claims to identify claims that may have been improperly billed to the COB plan for further investigation
• Ensures data is accurate and updated for efficient claims processing
• Monitor claims to ensure co-pay cards are utilized and billed properly
• Research, identify, and communicate errors
• Verify co-pay card fund availability
• Maintain current knowledge of various types of COB and third-party payer rules
• Meet all regulatory, contractual, or other requirements
• Other duties as assigned

Requirements / Qualifications

• Experience as a health care claims processor or in a medical facility billing office where COB verification is an integral function is a plus
• Demonstrated knowledge of, and proficiency in, Word, Excel, and Outlook required
• Flexibility and ability to manage multiple tasks. Demonstrated organizational skills and attention to detail
• Ability to work effectively with a variety of people both within and outside of the organization by phone, via webinar and email

Preferred

• 1 – 3 years pharmacy claims processing experience 

Work From Home Requirements

The employee must provide their own reliable, high-speed internet with sufficient bandwidth (25/25mp) to execute all job functions. Additionally, the employee must provide a private workspace with a desk and chair, free from distraction.

Physical Demands and Working Conditions

Duties are performed primarily in a home office setting utilizing Company provided computer equipment. While performing the duties of this job, you will regularly sit and talk. The employee is frequently required to use their hands. Employees will occasionally be required to stand and walk.

Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Benefits

• Health
• Dental
• Vision
• STD, LTD, Critical Illness and Accident
•  Company Paid Life Insurance 
• 401(k) 100% company match up to 4%