In this essential operational role, you will analyze and process routine pharmacy claims, ensuring that benefit payouts are handled with maximum accuracy and compliance. This role balances independent problem-solving with structured procedural guidelines, making it the perfect match for a focused individual with a sharp eye for detail. If you are ready to apply your claims adjudication and customer service talents to a high-visibility role with strong potential for permanent career conversion, we want to see your application!
salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
Position Summary: Adjudicate and process routine pharmacy claims within a single product line under close supervisor support. This role focuses on verifying client coverage, checking policy data windows, and calculating accurate benefit payouts in accordance with strict corporate guidelines.
Key Responsibilities:
- Review, investigate, and process standard pharmacy and medical claims to determine appropriate benefit payouts.
- Cross-reference incoming claims against established internal policies, department guidelines, and compliance rules.
- Research and resolve routine processing discrepancies or system errors independently.
- Maintain exceptional data integrity by accurately entering data into specialized pharmacy database systems.
- Deliver professional, empathetic phone-based or digital customer support to resolve complex inquiries from internal teams.
- High School Diploma or equivalent credential is required.
- Minimum of 6 months of hands-on experience in healthcare claims examining, or successful completion of a dedicated claims processing technical program.
- Direct prior experience handling pharmacy or medical claims processing operations.
- strong professional communication skills with a background in customer service or phone support.
- High proficiency navigating computer systems, including Microsoft Office (Word, Excel, Outlook).
- Must pass standard pre-employment onboarding compliance checks prior to your start date.
Skills
Qualifications
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.
