Claims Processing Supervisor jobs in Orlando, FL

AssistRx has engineered the perfect blend of technology and talent to provide life sciences companies with an efficient solution to improve patient uptake, visibility and outcomes. Our talented team members provide therapy and healthcare system expertise to help patients achieve better results from care. As a growing organization, AssistRx views our people as our strongest asset. Join us as we continue to make a difference....

The Copay Lead is a critical role within the organization and is primarily responsible for the set-up and administration of Copay programs for AssistRx manufacturer clients. Required engagement with program managers, finance team members and other departments within the organization to support all operational and financial processes related to claim processing activities ensuring effective day-to-day operations and provide ongoing Copay program metrics for customer business review meetings. Responsible for utilizing forecasts and analyzing claims data to determine Copay utilization, escrow account replenishment needs, identify Copay trends and make recommendations based on Copay claim activity to implement data-driven initiatives to achieve operational and process excellence that will optimize the Copay program.

• Primary Patient Solutions contact assisting in affordability program design, affordability program business rules determination, set-up and maintenance of Copay programs and other AssistRx adjudicated program offerings
• Gains a thorough understanding of the adjudication claims engines and networks, including the variation of system logics across multiple adjudicators
• Must be proficient in accessing the data from affordability program platforms and in being able to analyze its significance regarding the functioning of a program's business rules
• Quickly responds to and resolves business rule questions or concerns escalated from internal teams or adjudicators
• Is primarily responsible for performing quality control on new Copay program set-ups and any requested updates
• Develops reports reflecting Copay claim activities and provides to the program business leaders for presentation to the clients
• Actively participates in periodic adjudication meetings with internal clients
• Participates in client facing calls and internal training presentations as the need arises
• Uses appropriate measurement, analysis and evaluation methods to accurately identify and document improvements
• Partners cross-functionally with key stakeholders and departments to build relationships and provide strategic and tactical thought processes to effectively drive results. P
• Partners with finance team on Copay claim billing and escrow balances
• Maintains a great work environment by teaching, training, developing and coaching HUB personnel on Copay programs and claim adjudication troubleshooting
• Responsible for data integrity
• Acts as a Subject Matter Expert and key contributor on complex or critical assignments, related to Copay and/or other affordability programs
• Performs other related duties as assigned by management
  
  
  

Requirements

• High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience
• Associate's Degree (AA) or equivalent from a two-year college or technical school, or six months to one year related experience and/or training, or equivalent combination of education and experience
• Computer skills required: Contract Management Systems; Microsoft Office
• Other skills required: Pharmacy Data Management (PDMI), PNC Card Platform
  
  
  

Benefits

• Supportive, progressive, fast-paced environment
• Competitive pay structure
• Matching 401(k) with immediate vesting
• Medical, dental, vision, life, & short-term disability insurance
  
  

AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.

All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position.

AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire.