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Claims Operations Associate Jobs in Kentucky (NOW HIRING)

Onco360

$21/hr

Provides thorough, accurate and timely responses to requests from pharmacy operations, providers ... Associate degree or equivalent program from a 2 year program or technical school, Certified ...

Cincinnati Insurance Company

$60 - $95/hr

... daily operations. To put this into action, we're looking for extraordinary people to join our ... Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be ...

New

Nationwide Mutual Insurance Company

$63 - $116/hr

... processes and operations to provide the best customer value, then Nationwide's Property and ... Our customers and partners are at the center of everything we do and we're looking for associates ...

New

Summit Consulting

$95 - $125/hr

With over 30 specialty and property and casualty operations, there are always opportunities here to ... Professional industry designations such as Associate in Claims (AIC) are preferred.* Ability to ...

Summit Consulting

$70 - $100/hr

With over 30 specialty and property and casualty operations, there are always opportunities here to ... Completion of or continuing progress toward a professional designation preferred, such as Associate ...

New

Cook Children's

$70 - $110/hr

This position collaborates with Claims Operation, Provider Contract, Compliance and Finance and ... Minimum of associate's degree, bachelor's preferred, or equivalent experience in healthcare claims ...

Palmetto GBA, LLC

$65 - $105/hr

... coding for claims/operations. Make reasonable payment determinations based on clinical medical ... Education: Associate degree - Nursing OR Graduate of an accredited School of Nursing. Work ...

New

Crew2, Inc

$90 - $130/hr

We empower our associates to be successful by promoting diversity and teamwork, providing ... Primary point of contact for customer concerns, escalations, and liability claims * Provide ...

New

Intact Insurance Group

$62 - $72/hr

Associate Operations Business Analyst - Surety (Hybrid) Job Category : Operations - Bus Analyst ... Develops understanding of interdependencies between various systems (policy administration, claims ...

New

AAA Cooper Transportation, Inc.

$72 - $88/hr

... claims and claim liability, assist in improving operational efficiencies and quality of service ... Employee Assistance Program Job Requirements Associate's degree or higher college completion ...

Posted today

Southcarolinablues

$70 - $90/hr

... coding for claims/operations. Make reasonable payment determinations based on clinical medical ... Education: Associate degree - Nursing OR Graduate of an accredited School of Nursing.* Work ...

Humana Inc

Compliance Lead (Pharmacy)

Louisville, KY · On-site

$115 - $158/hr

... associates within the team.# **Use your skills to make an impact****Required Qualifications*** Bachelor's degree.* Five (5) years of pharmacy experience in claims operations.* Four (4) or more years ...

Starr Insurance Companies

$68 - $78/hr

As an Associate, you will work in one of Starr's various departments, learning the business and ... Starr's operations. Program Benefits * Build confidence and foundational expertise through ...

Posted today

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All JobsClaims Operations Associate JobsClaims Operations Associate Jobs in Kentucky

Claims Operations Associate information

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How much do claims operations associate jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for claims operations associate in Kentucky is $18.23, according to ZipRecruiter salary data. Most workers in this role earn between $14.81 and $20.05 per hour, depending on experience, location, and employer.

What is a claims operations associate?

A Claims Operations Associate is a professional who supports the processing and administration of insurance claims. They handle tasks such as reviewing claim forms, verifying information, entering data into systems, and assisting claims adjusters or examiners with documentation and communications. Their role is crucial in ensuring that claims are processed efficiently, accurately, and in compliance with company policies and regulatory requirements. Claims Operations Associates may work for insurance companies, healthcare providers, or third-party administrators.

What skills and qualifications are needed to be a claims operations associate?

To thrive as a Claims Operations Associate, you need strong analytical abilities, attention to detail, and a solid understanding of insurance processes, often supported by a bachelor's degree or relevant experience. Familiarity with claims management systems, Microsoft Office Suite, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent communication, organizational skills, and problem-solving abilities help you manage complex claims and collaborate effectively with internal and external stakeholders. These competencies ensure accurate, efficient claims processing and contribute to customer satisfaction and organizational compliance.

What challenges might a claims operations associate encounter in their daily work?

As a Claims Operations Associate, you may encounter challenges such as managing a high volume of claims while ensuring accuracy and compliance with regulations. Balancing timely processing with the need to investigate discrepancies or incomplete information can be demanding. Additionally, you'll often coordinate with adjusters, customers, and other departments, so strong communication and organizational skills are essential. Staying up to date with changing policies or industry standards can also be a key part of the role.

What is the difference between Claims Operations Associate vs Claims Analyst?

AspectClaims Operations AssociateClaims Analyst
CredentialsHigh school diploma or equivalent; some roles may require relevant certificationsHigh school diploma; some roles may prefer certifications like CPCU or similar
Work EnvironmentOffice setting, handling claims processing and customer interactionsOffice or remote, analyzing claims data and making decisions
Employer & IndustryInsurance companies, third-party administratorsInsurance firms, claims departments
Search & Comparison IntentUnderstanding entry-level claims roles and responsibilitiesAnalyzing claims data and decision-making processes

The Claims Operations Associate typically handles claims processing tasks, customer service, and administrative duties within an insurance setting. In contrast, a Claims Analyst focuses more on analyzing claims data, assessing risks, and making decisions based on policy details. Both roles require knowledge of insurance policies and claims procedures, but the Claims Analyst often involves more analytical skills and data interpretation.

How much do claims operations associates make in the US?

Claims operations associates in the US typically earn an average salary ranging from $40,000 to $60,000 per year, depending on experience, location, and company size. Entry-level roles may start lower, while experienced professionals or those with specialized skills can earn higher salaries. Benefits often include health insurance, paid time off, and opportunities for advancement.

Is claims processing a stressful job?

Claims processing as a Claims Operations Associate can be stressful due to the need for accuracy, attention to detail, and meeting deadlines. The role often involves handling complex cases and working under time pressure, which can contribute to job-related stress. However, workload and stress levels vary depending on the employer and individual workload management skills.

What cities in Kentucky are hiring for Claims Operations Associate jobs?

Cities in Kentucky with the most Claims Operations Associate job openings:

Claims Operations Associate jobs near you
Infographic showing various Claims Operations Associate job openings in Kentucky as of August 2026, with employment types broken down into 85% Full Time, 12% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $37,914 per year, or $18.2 per hour.

Pharmacy Claims Adjudication Specialist

Onco360

Louisville, KY • On-site

$21/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 8 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 113 rated pharmacies

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Louisville, KY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style.
Shift times currently between 8am and 8pm.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Starting salary from $21.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before September 30th, 2026.
We offer a variety of benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits - life; and short and long-term disability

Pharmacy Adjudication Specialist Major Responsibilities:
The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
Pharmacy Adjudication Specialists at Onco360...
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
  • Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
  • Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
  • Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
  • Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
  • Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
  • Documents and submit requests for Patient Refunds when appropriate.
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Pharmacy Adjudication Specialist Qualifications and Responsibilities...
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
    • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
  • Work Experience
    • Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
    • Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
  • Skills/Knowledge
    • Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
    • Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
  • Licenses/Certifications
    • Required: Registration with Board of Pharmacy as required by state law
    • Desired: Certified Pharmacy Technician (PTCB)
  • Behavior Competencies
    • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills

#Company Values: Teamwork, Respect, Integrity, Passion
#IH

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