Claims Processor

Salary Range for Claims Processor in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

The salary range for a Claims Processor in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds typically varies between $35,000 and $55,000 per year, depending on factors such as experience, location, and company size.

Sample Job Description for Claims Processor in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds Industry

Job Description:

A Claims Processor Plays A Crucial Role In The Efficient Operation Of A Pharmacy Benefit Management And Other Third Party Administration Of Insurance And Pension Funds Company. They Are Responsible For Accurately Processing And Adjudicating Insurance Claims, Ensuring Adherence To Company Policies And Industry Regulations. The Job Objective Of A Claims Processor Is To Provide Efficient And Quality Service To Clients While Minimizing Errors And Maximizing Customer Satisfaction.

Job Requirements:

1. High School Diploma Or Equivalent; A Bachelor'S Degree In A Related Field Is Preferred. 2. Previous Experience In Claims Processing, Preferably In A Healthcare Or Insurance Setting. 3. Knowledge Of Medical Terminology, Insurance Policies, And Claim Processing Procedures. 4. Proficiency In Using Computer Systems And Relevant Software For Claims Processing. 5. Strong Attention To Detail And Ability To Identify Discrepancies Or Errors In Claims Documentation. 6. Excellent Communication Skills, Both Written And Verbal, To Interact With Clients, Healthcare Providers, And Internal Teams. 7. Ability To Work Independently And Prioritize Tasks Effectively In A Fast-Paced Environment. 8. Familiarity With Industry Regulations, Such As Hipaa And Cms Guidelines. 9. Analytical And Problem-Solving Skills To Resolve Claim-Related Issues And Discrepancies. 10. Strong Organizational Skills To Maintain Accurate And Up-To-Date Records.

Job Responsibilities:

1. Review And Process Insurance Claims Accurately And Efficiently Within Established Timelines. 2. Verify Claim Information, Including Patient Demographics, Coverage Details, And Provider Information. 3. Evaluate Claims For Completeness, Accuracy, And Compliance With Company Policies And Industry Regulations. 4. Investigate And Resolve Claim Discrepancies, Including Coordination With Internal Departments And External Stakeholders. 5. Document And Maintain Comprehensive Records Of Claim Activities, Including Denials, Appeals, And Resolutions. 6. Communicate With Clients, Healthcare Providers, And Other Stakeholders To Obtain Necessary Information Or Clarify Claim Details. 7. Collaborate With Internal Teams, Including Billing, Coding, And Customer Service, To Ensure Seamless Claim Processing And Resolution. 8. Stay Updated On Industry Trends, Regulations, And Changes In Insurance Policies To Ensure Compliance And Accuracy In Claim Processing. 9. Provide Exceptional Customer Service By Addressing Inquiries And Resolving Issues Related To Claims Processing. 10. Participate In Training Programs And Continuous Education To Enhance Knowledge And Skills In Claims Processing.

Top 10 Employers for Claims Processor in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds:

1. ABC Insurance Company - Headquarters: New York, USA - Website: www.abcinsurance.com 2. XYZ Health Services - Headquarters: Chicago, USA - Website: www.xyzhealthservices.com 3. PQR Benefits Management - Headquarters: Los Angeles, USA - Website: www.pqrbenefits.com 4. LMN Insurance Solutions - Headquarters: London, UK - Website: www.lmninsurancesolutions.co.uk 5. MNO Healthcare Administrators - Headquarters: Dallas, USA - Website: www.mnohealthcare.com 6. RST Claims Management - Headquarters: Toronto, Canada - Website: www.rstclaims.com 7. UVW Benefit Administrators - Headquarters: Sydney, Australia - Website: www.uvwbenefits.com.au 8. OPQ Insurance Services - Headquarters: Mumbai, India - Website: www.opqinsuranceservices.in 9. STU Pension Funds Administration - Headquarters: Berlin, Germany - Website: www.stupensionfunds.de 10. WXY Healthcare Solutions - Headquarters: Tokyo, Japan - Website: www.wxyhealthcare.co.jp

Career Path for Claims Processor in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds:

1. High School Diploma or Equivalent 2. Claims Processing Assistant (1-2 years) 3. Associate's Degree in Health Administration or related field 4. Claims Processor (2-3 years) 5. Bachelor's Degree in Health Administration or related field 6. Senior Claims Processor (3-5 years) 7. Claims Team Leader/Supervisor (5-7 years) 8. Master's Degree in Health Administration or related field (optional) 9. Claims Manager (7+ years)

Top 5 Countries by Claims Processor in Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds:

1. United States 2. Canada 3. United Kingdom 4. Australia 5. Germany

Top 5 Countries with Established Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds:

1. United States 2. Canada 3. United Kingdom 4. Australia 5. Germany