Remote Claims Processor Jobs in Kent, WA (NOW HIRING)

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Responsibilities

• Research and resolve pharmacy contract related inquires; evaluate network participation and distribute pharmacy contract documents; coordinate timely, accurate and complete submission of contract deliverables, and the electronic and physical tracking, storage and distribution of contract documents
• Ensure all contractual obligations adhere with company policies, regulatory compliance and legal requirements; engage with Legal and Network Management leadership as needed to ensure the language provided is accurate and concise
• Establish, develop, and maintain relationships with independent pharmacy providers
• Manage legal-to-legal correspondences between Prime and independent Pharmacy Providers escalating to Prime Legal Counsel as required
• Conduct root cause analysis, including but not limited to, investigating, monitoring, resolving and reporting for pharmacy contract and pricing analysis complaints issues
• Evaluate pharmacy inquiries to include but not limited to complaints, issues and/or grievances and collaborate with internal stakeholders, such as Network Management, Client Engagement, and Benefit Operation
• Manage and edit Prime's Provider Manual to ensure compliance and timely distribution, while contributing to process improvements that support cross-functional projects, regulatory changes, and client implementations
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Business or related area of study, or equivalent combination of education and/or relevant work experience; High school diploma or GED required

• 5 years of work experience in a call center, customer service, operations, retail pharmacy, pharmacy technician, Pharmacy Benefit Management (PBM)

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Strong interpersonal communication skills including conflict resolution and listening
• Advanced ability to problem solve and interpret complex data
• Proficiency within Microsoft applications such as Outlook, Word and Excel
• Enhanced ability to coordinate multiple tasks and projects simultaneously under strict timelines
• Ability to work in fast-paced, collaborative team environment
• Enhanced ability to establish rapport and effectively influence at all levels within an organization

Preferred Qualifications

• Experience analyzing state and federal regulations
• Experience working with RxClaim system or other claims processing experience
• Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
• Experience with negotiating contracts
• Salesforce experience
• Experience reviewing and responding to questions related to contracts
• Familiarity with reviewing and managing contract redlines
• Experience supporting or coordinating the execution of contracts

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLCis proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.