Medical Claims Jobs in Raleigh, NC (NOW HIRING)

This role supports pharmacy operations by handling a high volume of inbound and outbound calls, coordinating prescription refills and deliveries, and ensuring patients, clinicians, and clients receive timely, accurate, and empathetic support. The Customer Support Representative maintains up-to-date patient information, assists with medical claims, and uses management information systems to provide clear status updates on prescriptions and insurance, contributing to a smooth and efficient pharmacy workflow.

• Handle inbound and outbound pharmacy calls to support patients, clinicians, and clients with a high level of customer service.
• Serve as the primary resource for outbound calls to address non-clinical customer inquiries, such as general prescription status and financial information, minimizing workflow interruptions for clinical staff.
• Schedule medication refills and deliveries and coordinate payment information so that patient profiles are accurate and distribution can ship orders in a timely manner.
• Directly respond to customer inquiries when appropriate and route calls to the correct staff to ensure prompt resolution and high customer satisfaction.
• Demonstrate empathy and professionalism when speaking with patients, addressing their questions, concerns, and needs during refill scheduling.
• Run medical claims and document concise, accurate progress notes so other team members can quickly assess the status of referrals.
• Use management information systems to answer questions about refill needs, provide status updates on pending and shipped prescriptions, verify insurance information, and generate copies of invoices upon request.
• Answer patient questions and concerns during refill scheduling and transfer calls to the clinical team, including pharmacists and nurses, when clinical input is required.
• Identify and report adverse events and product complaints to clinicians to support patient safety and ensure appropriate follow-up.
• Perform data entry related to prescriptions, insurance, and claims to maintain accurate and up-to-date records.
• Collaborate with team members and follow program-specific workflows and procedures to meet performance metrics and service standards.
• Perform other duties as assigned, recognizing that specific tasks may vary depending on team and program requirements.

• Customer service skills with the ability to provide a high level of support to patients, clinicians, and clients.
• Experience or familiarity working in a call center environment.
• Ability to use management information systems to access and update patient, prescription, and insurance information.
• Proficiency with Microsoft applications, including basic computer navigation and data entry.
• Excellent verbal and written communication skills to clearly explain information and document interactions.
• Professional telephone manner with a polite, clear, and confident communication style.
• Ability to show empathy and patience when talking to patients and addressing sensitive concerns.
• Strong attention to detail when scheduling deliveries, processing claims, and updating records.
• Basic knowledge of pharmacy, prescriptions, or pharmacy workflows, with the ability to learn program-specific processes.
• Ability to handle medical claims and insurance-related inquiries accurately and efficiently.
• Capacity to work in a structured, metric-driven environment and meet attendance and performance expectations.

• Pharmacy technician certification or registration is preferred; being a Registered Pharmacy Technician in North Carolina is preferred but not required.
• Prior experience in a pharmacy setting, including retail pharmacy, is a plus but not required.
• Customer service experience, especially in a call center, is preferred.
• Medical office experience and knowledge of medical terminology are preferred.
• Experience with prior authorizations, insurance processes, or medical claims is a plus but not required.
• Experience with data entry and handling sensitive information accurately is beneficial.
• Ability to adapt to changing program requirements and workflows.
• Motivation to grow within a temporary-to-permanent opportunity based on performance and attendance.

This position is based in a call center environment focused on pharmacy operations. Training is conducted onsite from 9:00 a.m. to 6:00 p.m., followed by a permanent schedule of 11:30 a.m. to 8:00 p.m., Monday through Friday. There may be rotating Saturday shifts approximately once a month, with a weekday off provided to balance the schedule. This role starts as an onsite position, with the possibility of transitioning to a hybrid schedule after approximately 90 to 120 days, contingent on meeting performance metrics and attendance guidelines. The role involves extensive phone work, use of management information systems, Microsoft applications, and standard office equipment in a structured, metric-driven setting. This is a temporary-to-permanent hire opportunity for individuals who consistently meet performance and attendance standards.

This is a Contract position based out of Cary, NC.

The pay range for this position is $22.00 - $22.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a hybrid position in Cary,NC.

This position is anticipated to close on Aug 21, 2026.

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