Medical Claims Processor

Responsibilities

• Verify insurance coverage for new and existing patients to support timely prescription fulfillment
• Pull and review customer accounts to assess eligibility, benefits, and coverage limitations
• Conduct detailed research across multiple systems and portals
• Initiate and complete outbound calls to insurance companies, pharmacies, and other partners to resolve coverage issues
• Accurately document findings, decisions, and next steps in internal systems
• Meet or exceed productivity expectations while maintaining accuracy
• Identify and escalate complex cases or discrepancies as appropriate
• Support patients requiring specialty, high-cost, or complex therapies through thorough and timely insurance determination

Requirements

• Previous experience in insurance verification, benefits investigation, pharmacy operations, or healthcare administration preferred
• Knowledge of medical insurance terminology
• Strong attention to detail and ability to process high volumes of information accurately
• Excellent reading comprehension and research abilities
• Comfortable making outbound calls to resolve insurance or coverage-related issues
• Strong problem-solving and critical-thinking skills
• Ability to manage productivity metrics in a fast-paced environment
• Basic computer proficiency and experience navigating multiple systems

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, IRA)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off
• Short Term & Long Term Disability
• Training & Development
• Wellness Resources