Claims Specialist

Being on medication is tough enough.

We want to make getting it the easy part .

Getting prescriptions to patients has become increasingly complex.

When things get messy along the prescription journey, pharmaceutical manufacturers rely on us to untangle the process and create a clear path—allowing patients to build trusting relationships with their medication brands.

We’re not only committed to taking the pain out of the prescription process, but we’re also devoted to bringing the brightest minds together under one roof.

We bring together diverse voices—engineers, pharmacists, customer service veterans, developers, program strategists and more—all with one vision.

Each perspective and experience makes ConnectiveRx better than the sum of its parts.

The Claims Specialist, under the direction of the Supervisor (with guidance from a Team Lead), is responsible for processing medical claims received from patients and/or HCPs across a broad product suite.

An individual in this role is expected to meet or exceed productivity and quality standards.

Associates possess a solid understanding of department processes, products, and operational tools/systems.

This position utilizes ConnectiveRx and 3rd party systems to process claims and respond to inquiries from patients, physicians, pharmacies, and clients.

The Associate may be assigned additional responsibilities by the Supervisor.

• Verifies the accuracy and completeness of claim forms and attachments, such as EOBs, EOPs, SPPs, and pharmacy receipts. Information is entered into adjudication systems as required. Claims are paid or rejected based upon system adjudication and/or application of business rules external to the systems. Consult with the Team Lead or Supervisor for complex claims or clarification of business rules. Obtains missing information by calling or writing customers using standard scripts or form letters. Based on volume, may also process claims and/or answer phones
• Refers to requests for escalation as needed and engages other internal areas such as Program Management, IT, and other Contact Center teams to resolve issues.
• Provide input and feedback to the Supervisor, Quality Management, and Training (among others) to improve processes, procedures, and training.
• Other projects and tasks as assigned
• High School or GED required
• 1+ years in a health care or case management setting