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claim specialist - correctional medicine Jobs in Houston

claim specialist - correctional medicine

claim specialist healthcare professional liability

Gallagher

<div><b>Introduction</b><br>
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div><br>
<b>Overview</b><br>
<div><b>
Salary:</b> Salary can be up to $120,000 per year, dependent upon experience</div><div><b>
Claims Background:</b> Professional Liability Claims, Paralegal experience, or related insurance support role<br>
<b>Jurisdictional Experience:</b> Open to any<br>
<b>Active Adjuster Licenses:</b> Must be willing to obtain all licenses as required by the manager within a specified timeframe</div><div>
</div><div>
The Claims Specialist within GB Specialty is responsible for managing moderately complex <b>Healthcare Professional Liability</b> claims. This role manages the full claim life cycle, including coverage analysis, investigation, evaluation, and resolution, while ensuring claims are handled in accordance with client expectations, policy obligations, and regulatory requirements.</div>
<br>
<b>How you'll make an impact</b><br>
<ul><li>
Analyzes coverage and settles moderately complex claims in Healthcare Professional Liability.</li><li>
Generally, incumbent does not work on workers&rsquo; compensation claims.</li><li>
Able to manage the full-life cycle of all assigned claims files.</li><li>
Analyzes coverage and determines defense obligations.</li><li>
Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.</li><li>
Creates reservation of rights and coverage denial letters.</li><li>
Negotiates settlements with clients, client attorneys, and Public Adjusters.</li><li>
Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.</li><li>
Prepares reserve and settlement authority requests for client and carrier approval.</li><li>
May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.</li><li>
Has a solid understanding of claims processing and the insurance brokerage business.</li><li>
Has a basic understanding of the terminology and case law associated with correctional medicine professional liability claims.</li><li>
Handles claims consistent with clients&rsquo; and corporate policies, procedures and best practices and in accordance with statutory, regulatory, and ethical requirements.</li><li>
Incumbents at this level should be able to work at full caseload capacity.</li></ul>
<br>
<b>About You</b><br>
<div><b>
Claims Background:</b> Paralegal experience, junior professional liability claims experience, or insurance claims support background, preferably within healthcare or medical professional liability</div><div><b>
Jurisdictional Experience:</b> Open to any<br>
<b>Active Adjusters&rsquo; Licenses:</b> Not required initially; must be willing to obtain licenses as directed</div><div></div><div><b><br>
Required:</b></div><br>
<div></div><ul><li>
Bachelor's Degree Required</li><li>
Minimum 2 years of experience in claims, insurance, paralegal, legal support, or a related environment.</li><li>
Strong insurance fundamentals and understanding of claims processes.</li><li>
Ability to analyze documentation, summarize facts, and support coverage and liability determinations.</li><li>
Computer proficiency with claims systems and standard business software.</li><li>
Must be able to obtain required adjuster licenses within designated timeframes.</li></ul><div><b><br>
Preferred:</b></div><ul><li>
Prior experience within healthcare (medical malpractice) claims is a plus</li></ul><div><b>
Behaviors:</b><ul><li>
Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, and communicate effectively in writing and verbally.</li><li>
Strong analytical skills to support claims decisions and issue resolution.</li><li>
Ability to interpret policies, records, and related documentation.</li></ul><div>
#LI-TJ1</div><div>
#GBSpecialtyCareers</div></div></div><div></div>

Claim Specialist - Healthcare Professional Liability

<div><b>Introduction</b><br>
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div><br>
<b>Overview</b><div><b><br>
Salary: </b>Salary for this position could go up to $119,000 per year, dependent upon experience.</div><div><div><b>
Jurisdictions:</b> Open to any</div><div><b>
Licenses:</b> Must be willing to obtain all licenses as required by the manager within a specified timeframe</div><div><b>
Location:</b> This role is eligible for fully remote work</div><div></div><div><br>
The Claims Specialist within GB Specialty is responsible for managing moderately complex <b>Healthcare Professional Liability</b> claims, with a primary focus on <b>Correctional Medicine</b>. This role manages the full claim life cycle, including coverage analysis, investigation, evaluation, and resolution, while ensuring claims are handled in accordance with client expectations, policy obligations, and regulatory requirements.</div></div>
<br>
<b>How you'll make an impact</b><br>
<ul><li>
Analyzes coverage and settles moderately complex claims in Correctional Medicine Professional Liability.</li><li>
Generally, incumbent does not work on workers&rsquo; compensation claims.</li><li>
Able to manage the full-life cycle of all assigned claims files.</li><li>
Analyzes coverage and determines defense obligations.</li><li>
Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.</li><li>
Creates reservation of rights and coverage denial letters.</li><li>
Negotiates settlements with clients, client attorneys, and Public Adjusters.</li><li>
Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.</li><li>
Prepares reserve and settlement authority requests for client and carrier approval.</li><li>
May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.</li><li>
Has a solid understanding of claims processing and the insurance brokerage business.</li><li>
Has a basic understanding of the terminology and case law associated with correctional medicine professional liability claims.</li><li>
Handles claims consistent with clients&rsquo; and corporate policies, procedures and best practices and in accordance with statutory, regulatory, and ethical requirements.</li><li>
Incumbents at this level should be able to work at full caseload capacity.</li></ul>
<br>
<b>About You</b><div><b><br>
Required:</b></div><ul><li><div>
Bachelor&rsquo;s degree required</div></li><li><div>
Minimum 2+ years of experience in handling professional liability claims</div></li><li><div>
Strong insurance fundamentals and understanding of claims processes.</div></li><li><div>
Ability to analyze documentation, summarize facts, and support coverage and liability determinations.</div></li><li><div>
Computer proficiency with claims systems and standard business software.</div></li><li><div>
Must be able to obtain required adjuster licenses within designated timeframes.</div></li></ul><div><b>
Preferred:
</b></div><ul><li>Prior experience within healthcare, medical malpractice, or correctional medicine claims a plus.</li><li>
Strong insurance background (carrier, TPA, brokerage, or claims support experience).</li><li>
JD preferred but not required</li></ul><div><b>
Behaviors:</b></div><div><ul><li>
Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, and communicate effectively in writing and verbally.</li><li>
Strong analytical skills to support claims decisions and issue resolution.</li><li>
Ability to interpret policies, records, and related documentation.</li></ul><div>
#LI-TJ1</div><div>
#GBSpecialtyCareers</div></div></div>

Claim Specialist - Correctional Medicine

Onco360 Oncology Pharmacy

<div>
 <strong>
  Pharmacy Prior Authorization Specialist &ndash; Onco360 Pharmacy
  <br/>
  <br/>
 </strong>
 <em>
  Houston, TX
 </em>
 |
 <em>
  Full-Time
 </em>
 |
 <em>
  Starting at $23.00/hr and up
  <br/>
  <br/>
 </em>
 <strong>
  Join a mission-driven team making a difference in the lives of cancer patients.
  <br/>
  <br/>
 </strong>
 Onco360 Pharmacy is seeking a
 <strong>
  Pharmacy Prior Authorization Specialist
 </strong>
 to join our dedicated team in Houston, TX. This is a full-time position ideal for candidates local to the area.
 <strong>
  Remote work possible after initial on-site training.
  <br/>
  <br/>
 </strong>
 <strong>
  Why Join Us?
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   A career with purpose: Help patients access life-saving medications.
  </li>
  <li>
   Supportive culture: We value teamwork, respect, integrity, and passion.
  </li>
  <li>
   Growth opportunities: We invest in your professional and personal development.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Company Benefits
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Medical; Dental; Vision
  </li>
  <li>
   401k with a match
  </li>
  <li>
   Paid Time Off and Paid Holidays
  </li>
  <li>
   Tuition Reimbursement
  </li>
  <li>
   Quarterly Incentive Bonus
  </li>
  <li>
   Paid Volunteer Day
  </li>
  <li>
   Referral Incentive Program
  </li>
  <li>
   Company Paid Life Insurance; and Short/Long-Term Disability
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You&rsquo;ll Do
  <br/>
  <br/>
 </strong>
 The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
 <br/>
 <br/>
 <strong>
  How You&rsquo;ll Do This
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Manage prior authorization requests and appeals with insurance carriers.
  </li>
  <li>
   Collaborate with physicians, pharmacists, and other departments.
  </li>
  <li>
   Ensure HIPAA compliance while handling sensitive patient information.
  </li>
  <li>
   Maintain accurate documentation of authorization details.
  </li>
  <li>
   Proactively monitor and renew expiring authorizations.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You Bring
  <br/>
  <br/>
 </strong>
 <em>
  <strong>
   Required:
   <br/>
   <br/>
  </strong>
 </em>
 <ul>
  <li>
   High School Diploma or GED
  </li>
  <li>
   1+ years of pharmacy or prior authorization experience
  </li>
  <li>
   Registration with Board of Pharmacy (as required by state law)
  </li>
  <li>
   Strong communication, organizational, and customer service skills
  </li>
  <li>
   Self-motivated, organized, detail-oriented, and adaptable to changing priorities
  </li>
  <li>
   Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred:
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Associate degree or Certified Pharmacy Technician (PTCB)
  </li>
  <li>
   3+ years of experience in pharmacy or prior authorizations
  </li>
  <li>
   Specialty pharmacy experience
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.
  <br/>
  <br/>
 </strong>
 <strong>
  #Company Values: Teamwork, Respect, Integrity, Passion
  <br/>
  <br/>
 </strong>
 #IH
</div>


Pharmacy Prior Authorization Specialist

Crane Worldwide Logistics

<div><p><b>Essential Job Functions</b></p>
<ul>
<li>Log and respond to all incoming cargo claims through the claims management system</li>
<li>Report appropriate claims to the insurance carrier in a timely manner</li>
<li>Develop action plans to move claims to resolution</li>
<li>Responsible for the adjustment and handling of all cargo liability claims from third parties</li>
<li>Partners with the insurer, insurance broker and TPA to ensure best claims practices are followed from submission to final resolution.</li>
<li>Handles subrogation recoveries</li>
<li>Responsible for maintaining all loss data in the claims data base.</li>
<li>Collect, organize, analyze and provide claim reports to management and other departments as required</li>
<li>Responsible for submitting claims to accounting for payment.</li>
<li>Ensure claims are paid as appropriate, following company procedure and approval levels. Book claims appropriately to the correct business units</li>
<li>Recognize and elevate claims to the Senior Manager that could have significate exposures to the company.</li>
<li>Communicates claims activities with the Senior Manager and appropriate parties as needed.</li>
<li>Participates in insurer claim file reviews and conducts regular internal claim reviews</li>
<li>Coordinate with insurance claim teams, holding them accountable for providing superior claim management services</li>
<li>Assist department with responding to internal and external requests for information</li>
<li>Other duties as assigned</li>
</ul>
<p><b>Other Skills &amp; Abilities</b></p>
<ul>
<li>Must have the ability to prioritize and follow through in providing accurate and reliable information in a fast-paced, multitasking environment</li>
<li>Understanding of basic accounting principles and processes; computer skills &ndash; including heavy Excel knowledge; verbal and written communication skills; adept at problem resolution.</li>
<li>Excellent computer skills; requires Excel competency.</li>
<li>Data investigation knowledge</li>
</ul>
<p><b>Physical Requirements</b></p>
<ul>
<li>Job requires the ability to use vision, adjust focus and work on a standard computer screen.</li>
<li>Job may require extended sitting or standing, use of standard office equipment.</li>
<li>Job will require presence on-site at the assigned work location.</li>
<li>Job requires attendance and dependability.</li>
</ul>
<p> <b>Education &amp; Experience</b></p>
<ul>
<li>2-3 years cargo claims handling. Accounting experience a plus</li>
<li>Knowledge of intermodal transportation, shipping industry standards and practices</li>
<li>Maritime, Air and domestic regulations (e.g. US COGSA, Hague-Visby Rule, Montreal Convention) preferred.</li>
<li>Prior experience in a claims management system preferred.</li>
</ul>
<p><b>WHY SHOULD YOU WORK FOR CRANE?</b></p>
<p>
At Crane, we believe in providing our employees with excellent benefits at a Great Place to Work.</p>
<p>
We offer:</p>
<ul>
<li>136 hours of Paid Time Off which equals 17 days for the year, that can be used for Sick Time or for Personal Use</li>
<li>Excellent Medical, Dental and Vision benefits</li>
<li>Tuition Reimbursement for education related to your job</li>
<li>Employee Referral Bonuses</li>
<li>Employee Recognition and Rewards Program</li>
<li>Paid Volunteer Time to support a cause that is close to your heart and contributes to our communities</li>
<li>Employee Discounts</li>
<li>Wellness Incentives that can go up to $100 per year for completing challenges, in addition to a discount on contribution rates</li>
<li>Potential to earn a quarterly bonus</li>
</ul>
<p>Come join the leader in logistics and take your career in the right direction.</p>
<p><b>
Disclaimer:</b></p>
<p>
The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.</p>
<p>
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p>
<p>
We maintain a drug-free workplace and perform pre-employment substance abuse testing.</p>
<p>
This position requires the final candidate to successfully pass an E-Verify Check.</p>
<p>
More Information: http://www.dhs.gov/e-verify</p>
<p>
Company benefits are contingent upon meeting eligibility requirements and plan conditions.</p>
<p>
We are preparing to comply with the Biden Administration's mandate on COVID-19 vaccination. Please be advised that employment with the Company may be contingent upon your ability to provide proof of vaccination except in limited circumstances where you are eligible for a legal accommodation.</p></div><p></p>

Global Cargo Claims Specialist

NPAworldwide

<div>
 <strong>
  Job Description
  <br/>
  <br/>
 </strong>
 In this role, you will assist with translating medical services into standardized billing codes, preparing claims for insurance reimbursement, supporting patient billing questions, and performing essential administrative tasks that keep clinical operations running smoothly. No prior medical office experience is required, but strong attention to detail and communication skills are essential.
 <br/>
 <br/>
 <strong>
  Key Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Translate medical procedures and diagnoses into standardized billing and coding formats
  </li>
  <li>
   Prepare and submit insurance claims with accuracy
  </li>
  <li>
   Review claims for completeness and correct coding errors when necessary
  </li>
  <li>
   Communicate with patients regarding billing questions, payment options, and payment plans
  </li>
  <li>
   Verify insurance information and update billing records
  </li>
  <li>
   Work closely with medical providers and administrative teams to ensure accurate claim documentation
  </li>
  <li>
   Perform general office tasks such as data entry, document processing, and file management
  </li>
  <li>
   Support ongoing billing, reimbursement, and coding workflow as assigned
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   High School diploma or equivalent
  </li>
  <li>
   MediClear or equivalent HIPAA certification (required)
  </li>
  <li>
   Strong attention to detail and accuracy
  </li>
  <li>
   Excellent communication and customer service skills
  </li>
  <li>
   Organized, dependable, and eager to learn
  </li>
  <li>
   Ability to manage multiple tasks in a structured office environment
  </li>
  <li>
   Basic computer proficiency; comfort with data entry
   <br/>
   <br/>
  </li>
 </ul>
 Preferred (Not Required)
 <br/>
 <br/>
 <ul>
  <li>
   Interest in medical billing, coding, or healthcare administration
  </li>
  <li>
   Coursework or certificates in billing/coding (optional)
  </li>
  <li>
   Experience in customer service or administrative roles
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Why Is This a Great Opportunity
  <br/>
  <br/>
 </strong>
 <strong>
  Benefits &amp; Career Growth
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   On-the-job training
  </li>
  <li>
   Opportunities for advancement within the organization
  </li>
  <li>
   Supportive, professional work environment
  </li>
  <li>
   Health insurance options
  </li>
  <li>
   Long-term stable career path in healthcare administration
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Salary Type
 </strong>
 : Hourly
 <br/>
 <br/>
 <strong>
  Salary Min
 </strong>
 : $ 22
 <br/>
 <br/>
 <strong>
  Salary Max
 </strong>
 : $ 32
 <br/>
 <br/>
 <strong>
  Currency Type
 </strong>
 : USD
</div>


Entry-Level Medical Billing & Coding Assistant

HCA Houston Healthcare

<p></p><div><h5 class="jobSectionHeader"><b>Introduction</b></h5><h5 class="jobSectionHeader"><p><b>
This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).</b></p><p><b>
Do you want to join an organization that invests in you as a Medical Insurance Collector? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.</b></p></h5><h5 class="jobSectionHeader"><b>
Job Summary and Qualifications</b></h5><p></p><h5 class="jobSectionHeader"><p><b><br>
The Healthcare Insurance Collector is responsible for performing account follow-up and resolution of insurance and patient receivables. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you. We want you to apply today!</b></p><p></p><p><b><br>
What you will do in this role:</b></p><p></p><ul><li><b><br>
Work insurance pools and contact insurance companies to resolve claims that are not paid in a timely manner.</b></li><li><b>
Review EOB&rsquo;s, remits and payer correspondence while performing account follow-up and escalate any identified issues to the appropriate area for review and response to expedite claim resolution.</b></li><li><b>
Identify problem accounts and escalate as appropriate.</b></li><li><b>
Maintain compliance with pool completion requirements.</b></li><li><b>
Maintain required productivity and QA standards.</b></li><li><b>
Document in the patient account record to identify actions taken on the account.</b></li><li><b>
Work with patients and guarantors resolve payer requests and discrepancies to promptly resolve pending claims.</b></li></ul><p></p><p><b><br>
 What qualifications you will need:</b></p><p></p><ul><li><b><br>
Minimum of 1-year related experience required, preferably in healthcare. Relevant education may substitute experience requirement.</b></li><li><b>
Previous experience with Insurance Follow Up is preferred.</b></li><li><b>
This is a work from home position that requires high-speed internet with 25 MB Download and 15 MB Upload. Wifi is not permitted.</b></li><li><b>
Ability to work uninterrupted for shift (not including breaks/lunch)</b></li></ul></h5><h5 class="jobSectionHeader"><b>
Benefits</b></h5><p></p><p>
Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:</p><ul><li><b>
Comprehensive benefits</b> for medical, prescription drug, dental, vision, behavioral health and telemedicine services</li><li><b>
Wellbeing support,</b> including free counseling and referral services</li><li><b>
Time away from work</b> programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence</li><li><b>
Savings and retirement resources</b>, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling</li><li><b>
Education support</b> through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing</li><li><b>
Additional benefits</b> for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts</li></ul><p>
Learn more about Employee Benefits</p><p><b><i>
Note: Eligibility for benefits may vary by location.</i></b></p><p>
&quot;</p><p><b>
Parallon</b> provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.</p><p>
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.</p><p>
&quot;</p><br>
<p>&quot;There is so much good to do in the world and so many different ways to do it.&quot;- Dr. Thomas Frist, Sr.<br>
HCA Healthcare Co-Founder<br>
</p><p>If you find this opportunity compelling, we encourage you to apply for our Medical Insurance Collector opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. <b>We are interviewing - apply today!</b></p><p><i>
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</i></p></div>

Medical Insurance Collector

Community Health Choice

<p><b>Job Overview</b><br/>Under the direction of the Manager, Managed Care Pharmacy Operation, the Pharmacy Program Specialist II supports the operational needs of the pharmacy team by managing prior authorization processes, coordinating communication between members and providers, and addressing issues with the Pharmacy Benefit Manager (PBM). The role requires a strong understanding of medical benefit drug coverage and adherence to regulatory timelines. The specialist also contributes to reporting, monitoring delegated PBM functions, and promoting member adherence, while delivering a high level of customer service.</p><p>QUALIFICATIONS:</p><p>Required Preferred Education/Specialized Training/Licensure: Bachelor&rsquo;s degree in healthcare field, or in business administration Actively registered with the Texas State Board of Pharmacy as a certified pharmacy technician</p><p>Work Experience (Years and Area): Minimum Three (3) years&rsquo; experience with a Health Plan or PBM in related functions Strong experience with prior drug authorization process in a Health Plan or PBM</p><p>Pay: $23.46 - $29.32 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Work Location: Hybrid remote in Houston, TX 77081</p>

Pharmacy Program Specialist II

Explore 343+ Claim specialist healthcare professional liability in Houston this May. Find roles across top companies and apply now to boost your career.