Pharmacy Claims Analyst

• Assist our Care Directors’ or their representatives in correcting daily invoicing and claims, including managing aging Accounts Receivables.
• Oversee the timely and accurate generation and delivery of customer monthly reports, ensuring that all billing information is correct and in compliance with the company’s policies and procedures, as well as client contracts.
• Maintain daily roll forwards.
• Ability to adjudicate pharmacy claims and confirm an insurance company is paying the contracted rate. Contact the insurance company and client for possible resolutions.
• Address and resolve client inquiries and disputes regarding billing issues, providing excellent customer service and maintaining positive relationships.
• Review and analyze billing data and reports to identify any discrepancies or errors and take appropriate actions to resolve them.
• Review customer accounts, ensuring that all billing records are up to date and accurately reflect the services provided.
• Performs other related duties as assigned or as necessary; remains flexible and adaptable in work schedules and work assignments as defined by departmental and organizational needs.

• A Bachelor’s degree, or 4-year equivalent, is required.
• A demonstrated knowledge of billing and financial reporting functions.
• Ability to maintain accurate financial records and prepare clear and accurate reports for informational purposes.
• Relentless attention to detail and the ability to be a creative self-starter and team player.
• Ability to make sound, independent judgments within established procedures, organize work and set priorities, meet critical deadlines, and communicate effectively with co-workers and managers.
• Knowledge of healthcare, PBM, and or/ pharmaceutical space is ideal.
• Proficient in Microsoft Office Suite, specifically Word, PowerPoint, and Outlook.
• Relentless attention to detail and the ability to be a creative self-starter and team player.
• Excellent interpersonal communication skills.
• Excellent oral and written communication skills.
• Must be self-motivated, assertive, and proactive.
• Motivated to grow in sync with company growth.
• Exceptional multitasking skills, including the ability to manage several competing priorities at the same time.
• Ability to participate in and facilitate group meetings.
• Ability to thrive in a fast-paced environment with constantly changing and competing priorities.
• Excellent analytical skills and the ability to provide solutions to complex problems.
• Ability to be highly transparent, ethical, and driven.

Optime Care provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.