Claims Processing Director jobs in Miami, FL

Bi-lingual Spanish Patient Support Medical Claims Processing ​ Representative
Contract Remote Role – Location (Open to Remote US)

As the only global provider of commercial solutions, IQVIA understands what it takes to deliver nationally and internationally.  Our teams help biopharma, medical device and diagnostic companies get their therapies to the people who need them.  We help customers gain insight and access to their markets and ultimately demonstrate their product’s value to payers, physicians, and patients.  A significant part of our business is providing patient support programs on the behalf of our customers.  With the right experience, you can help provide support to patients in need of available therapies.

IQVIA has the world’s largest Commercial Sales & Medical Solutions (CSMS) organization dedicated to the launch and marketing of pharmaceutical and medical products.  With a focus on providing talent for patient support, field/inside sales, medical device support, clinical support, and medical affairs our CSMS division has 10,000 field professionals in more than 30 countries addressing physician and patient needs.

We are excited to announce that currently we are looking for a 100% remote (work from home—WFH) contact Patient Support Medical Claims Processing Representative to join our team.  In this position, you will provide payment assistance solutions such as co-pay cards or vouchers. The Patient Support Call Center Representative is primarily responsible for receiving medical claims from HCPs or patients and vetting the claim against program specific business rules to determine if the claim should be paid or rejected.  This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.

Job Responsibilities:

• Primary responsibilities involve receiving medical claims from HCPs or patients, ensuring the adequate supporting documentation has been provided, interpreting the EOB/CMS1500, vetting the claim against program specific business rules and ultimately determining if the claim should be paid or rejected
• Exceptional organizational skills are required
• May provide support as needed for customer requests via telephone, email, fax, or other available means of contact to the Support Center
• Requires the ability to recognize operational challenges and suggest recommendations to management, as necessary
• Ability to work 40 hours per week (two shifts: 8:30 am EST – 5:30 pm EST or 11:00 am EST – 8:00pm EST) under moderate supervision

Minimum Education & Experience:

• High School Diploma or equivalent
• Experience in claim processing required
• Medical Billing and Coding Certification required
• Ability to interpret Explanation of Benefits (EOB)
• HIPPA certified
• Customer Service Experience preferred
• Pharmacy Technician experience preferred
• Bi-lingual (English/Spanish) is required

The pay range for this role is $23.00 per hour.

IQVIA is an Equal Opportunity Employer. We cultivate a diverse corporate culture across the 100 countries where we operate, celebrating and rewarding teamwork and inclusiveness. By embracing our differences, we create innovative solutions that are good for IQVIA, our clients, and the advancement of healthcare everywhere.  This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.

IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. We believe in pushing the boundaries of human science and data science to make the biggest impact possible – to help our customers create a healthier world. Learn more at https://jobs.iqvia.com

We are committed to providing equal employment opportunities for all, including veterans and candidates with disabilities. https://jobs.iqvia.com/eoe

IQVIA’s ability to operate and provide certain services to customers and partners necessitates IQVIA and its employees meet specific requirements regarding COVID-19 vaccination status. https://jobs.iqvia.com/covid-19-vaccine-status