Claims examiner

Are you a detail-oriented claims professional looking for a flexible, work-from-home opportunity? We are seeking a dedicated Claims Examiner to join an inclusive, collaborative Pharmacy Operations team! In this key role, you will review and process routine pharmacy and medical claims, ensuring accurate benefit reimbursements in accordance with plan guidelines and state regulations.

Working comfortably from your home office on a steady Monday through Friday Pacific Time schedule (8:00 AM - 5:00 PM PST), you will manage a variety of claim types-including coordination of benefits, accumulator audits, compound claims, and Medicare secondary payor reviews. If you bring strong claims processing experience, sharp attention to detail, and a focus on quality, this is a fantastic opportunity to apply your expertise with an industry leader offering great work-life balance and career growth potential.

salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

Position Summary:

Process routine pharmacy and medical claims, perform accumulator reviews, and audit explanation of benefits while ensuring strict adherence to plan provisions and quality standards.

Key Responsibilities:

• Review and process routine pharmacy/medical claims, including coordination of benefits, foreign claims, copay adjustments, and Medicare secondary payor.
• Perform pharmacy accumulator audits and verify Rx copay card usage for brand-name medications.
• Match authorizations to claims and handle member eligibility updates in system records.
• Research missing information, review appeals, and communicate telephonically or in writing with pharmacies, providers, and internal teams to resolve claim issues.

Requirements:

• High School Diploma or equivalent required.
• Minimum 6 months to 1+ years of pharmacy or medical claims processing experience.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook).
• strong customer service, communication, and phone skills.
• Preferred: Pharmacy Technician License or medical billing background.

Skills

• Claims
• Claims Processing
• Workers Compensation Reporting Claims

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.


Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on click.appcast.io.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.


Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.


Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.


We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.