Ohio Licensed Pre-Payment Claims Analyst

A company is looking for a Pre-Payment Claims Analyst to analyze pharmacy claim data and identify overpayments.

Key Responsibilities

Research and analyze pre-payment pharmacy claim data to identify overpayments and errors

Develop and update educational materials, workflows, and operational reports

Review and audit pharmacy claims for accuracy and compliance, and resolve related concerns

Required Qualifications, Training, and Education

National Pharmacy Technician Certification (CPhT) required

Bachelor's or Master's degree in a related field preferred, or equivalent work experience

Minimum of 2 years of experience in claim analytics or related healthcare fields

Proficient in Microsoft Office, especially Excel and Access

Working knowledge of pharmacy claims payment processes and systems