Claims Specialist

PrudentRx

Claims Specialist handling health care claims processing at PrudentRx. Ensure accurate data processing and monitor claims for discrepancies in a remote work environment.

Posted 4/23/2026full-timeRemote • 🇺🇸 United StatesJuniorWebsite

About the role

Key responsibilities & impact

Review and analyze claims to identify claims that may have been improperly billed to the COB plan for further investigation
Ensures data is accurate and updated for efficient claims processing
Monitor claims to ensure co-pay cards are utilized and billed properly
Research, identify, and communicate errors
Verify co-pay card fund availability
Maintain current knowledge of various types of COB and third-party payer rules
Meet all regulatory, contractual, or other requirements
Other duties as assigned

Requirements

What you’ll need

Experience as a health care claims processor or in a medical facility billing office where COB verification is an integral function is a plus
Demonstrated knowledge of, and proficiency in, Word, Excel, and Outlook required
Flexibility and ability to manage multiple tasks.
Demonstrated organizational skills and attention to detail
Ability to work effectively with a variety of people both within and outside of the organization by phone, via webinar and email
Preferred 1 – 3 years pharmacy claims processing experience

Benefits

Comp & perks

Health
Dental
Vision
STD, LTD, Critical Illness and Accident
Company Paid Life Insurance
401(k) 100% company match up to 4%

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims processingCOB verificationdata analysiserror identificationregulatory compliancepharmacy claims processing

Soft Skills

organizational skillsattention to detailflexibilitycommunication skillsability to manage multiple tasks