Claims Tester

  • location: Bloomfield, CT
  • type: Contract
  • salary: $27 - $33 per hour
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job description

Claims Tester

job summary:
Claims Tester - Bloomfield, CT

  • This is a contract role expected to last 4 months.
  • This role will assist with activities and projects associated with existing and new Pharmacy Client Specific Networks as well as any other network offerings in development, or being established in the future. Responsibilities include the creation, documentation and ongoing updates to our operating procedures and policies. This role will be the primary resource in researching and resolving claim processing issues, coordinating claim remediation, customer service issues and coordinating provider relation issues with our external PBM vendor.
Claims Tester - Job Activities:

  • Participates in and supports key Retail Channel Management initiatives and projects.
  • Write, revise and recommend enhancements to Standard Operating Procedures and Policy & Procedures.
  • Research and resolve claim processing logic issues related to adjudication.
  • Perform claim compare activities during projects or remediations.
  • Work with internal and external partners to ensure that direct contracted reimbursement rates and claim processing logic are appropriately reflected in all systems and appropriate reports.
  • Assist in collaborative work efforts with the Pharmacy Implementation Managers and Argus to successfully build Client Specific Networks in Argus system.
  • Assist in writing Customer Service /Scope and Assessment Requests and participates in claim test review and signoff.
  • Assist in the coordination of claim remediation.
Job Responsibilities:

  • Claim Testing: New and updating CSN claim testing, project test macro submission, and initial review of results
  • RxNova Intel Reporting: Run ad hoc claim utilization reports as issues arise
  • CSN Review: Run CSN claim utilization reports regularly to verify claim processing according to CSN parameters
  • Reliability Issues: Perform first pass analysis on reliability files
  • Claim Research: Perform basic-level claim research in Argus GUI
Job Requirements:

  • 2 to 5 years of Pharmacy experience required
  • Argus claim adjudication system experience required
  • Pharmacy claims and processing logic experience required
  • Familiarity with pharmacy industry (PBM), concepts and terminology highly preferred.
Compensation: $27.00-$33.58/hr

 
location: Bloomfield, Connecticut
job type: Contract
salary: $27 - 33 per hour
work hours: 8 to 5
education: High School
experience: 3 Years
 
responsibilities:
Claims Tester - Bloomfield, CT

  • This is a contract role expected to last 4 months.
  • This role will assist with activities and projects associated with existing and new Pharmacy Client Specific Networks as well as any other network offerings in development, or being established in the future. Responsibilities include the creation, documentation and ongoing updates to our operating procedures and policies. This role will be the primary resource in researching and resolving claim processing issues, coordinating claim remediation, customer service issues and coordinating provider relation issues with our external PBM vendor.
Claims Tester - Job Activities:

  • Participates in and supports key Retail Channel Management initiatives and projects.
  • Write, revise and recommend enhancements to Standard Operating Procedures and Policy & Procedures.
  • Research and resolve claim processing logic issues related to adjudication.
  • Perform claim compare activities during projects or remediations.
  • Work with internal and external partners to ensure that direct contracted reimbursement rates and claim processing logic are appropriately reflected in all systems and appropriate reports.
  • Assist in collaborative work efforts with the Pharmacy Implementation Managers and Argus to successfully build Client Specific Networks in Argus system.
  • Assist in writing Customer Service /Scope and Assessment Requests and participates in claim test review and signoff.
  • Assist in the coordination of claim remediation.
Job Responsibilities:

  • Claim Testing: New and updating CSN claim testing, project test macro submission, and initial review of results
  • RxNova Intel Reporting: Run ad hoc claim utilization reports as issues arise
  • CSN Review: Run CSN claim utilization reports regularly to verify claim processing according to CSN parameters
  • Reliability Issues: Perform first pass analysis on reliability files
  • Claim Research: Perform basic-level claim research in Argus GUI
Job Requirements:

  • 2 to 5 years of Pharmacy experience required
  • Argus claim adjudication system experience required
  • Pharmacy claims and processing logic experience required
  • Familiarity with pharmacy industry (PBM), concepts and terminology highly preferred.
Compensation: $27.00-$33.58/hr

 
qualifications:
Claims Tester - Bloomfield, CT

  • This is a contract role expected to last 4 months.
  • This role will assist with activities and projects associated with existing and new Pharmacy Client Specific Networks as well as any other network offerings in development, or being established in the future. Responsibilities include the creation, documentation and ongoing updates to our operating procedures and policies. This role will be the primary resource in researching and resolving claim processing issues, coordinating claim remediation, customer service issues and coordinating provider relation issues with our external PBM vendor.
Claims Tester - Job Activities:

  • Participates in and supports key Retail Channel Management initiatives and projects.
  • Write, revise and recommend enhancements to Standard Operating Procedures and Policy & Procedures.
  • Research and resolve claim processing logic issues related to adjudication.
  • Perform claim compare activities during projects or remediations.
  • Work with internal and external partners to ensure that direct contracted reimbursement rates and claim processing logic are appropriately reflected in all systems and appropriate reports.
  • Assist in collaborative work efforts with the Pharmacy Implementation Managers and Argus to successfully build Client Specific Networks in Argus system.
  • Assist in writing Customer Service /Scope and Assessment Requests and participates in claim test review and signoff.
  • Assist in the coordination of claim remediation.
Job Responsibilities:

  • Claim Testing: New and updating CSN claim testing, project test macro submission, and initial review of results
  • RxNova Intel Reporting: Run ad hoc claim utilization reports as issues arise
  • CSN Review: Run CSN claim utilization reports regularly to verify claim processing according to CSN parameters
  • Reliability Issues: Perform first pass analysis on reliability files
  • Claim Research: Perform basic-level claim research in Argus GUI
Job Requirements:

  • 2 to 5 years of Pharmacy experience required
  • Argus claim adjudication system experience required
  • Pharmacy claims and processing logic experience required
  • Familiarity with pharmacy industry (PBM), concepts and terminology highly preferred.
Compensation: $27.00-$33.58/hr

 
skills: Excel
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.

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