CPhT Certified Claims Analyst

A company is looking for a Claims Analyst - Remote US. Key Responsibilities Analyze pre-payment pharmacy claims data to identify potential overpayments and ensure accurate claims processing Audit pharmacy claims and documentation for reimbursement accuracy and compliance with contract terms Investigate claims issues, including overpayments and denials, and collaborate with stakeholders to resolve them Required Qualifications Must be a Nationally Certified Pharmacy Technician (CPhT) At least 2 years of experience in claims analysis, processing, or auditing in healthcare Experience in managed care, insurance, or pharmacy benefit management preferred Proficiency with pharmacy claims payment configuration systems and MS Office, especially Excel and Access Ability to recognize data discrepancies and perform root cause analysis for process improvement

Apr 22, 2025 - 22:10

A company is looking for a Claims Analyst - Remote US. Key Responsibilities Analyze pre-payment pharmacy claims data to identify potential overpayments and ensure accurate claims processing Audit pharmacy claims and documentation for reimbursement accuracy and compliance with contract terms Investigate claims issues, including overpayments and denials, and collaborate with stakeholders to resolve them Required Qualifications Must be a Nationally Certified Pharmacy Technician (CPhT) At least 2 years of experience in claims analysis, processing, or auditing in healthcare Experience in managed care, insurance, or pharmacy benefit management preferred Proficiency with pharmacy claims payment configuration systems and MS Office, especially Excel and Access Ability to recognize data discrepancies and perform root cause analysis for process improvement