Prime Therapeutics - Springfield, IL
posted 2 months ago
As a Claims Lead at Prime Therapeutics, you will play a crucial role in ensuring that claims are processed accurately and efficiently. Your primary responsibility will be to adjudicate or submit claims and adjustments as required, ensuring compliance with Prime Therapeutics contracts. You will also be tasked with the implementation and maintenance of claims processing programs and procedures, which are vital for the smooth operation of our claims department. This position requires a keen eye for detail and the ability to manage multiple projects and administrative duties as dictated by business needs. In addition to your core responsibilities, you will track and trend performance through root cause analysis, providing additional training as needed to enhance team performance. You will be expected to resolve claims edits and suspended claims, ensuring that all claims are handled with a high level of quality and professionalism. As a leader, you will implement positive changes within the team, fostering an environment of collaboration and continuous improvement. You will also provide backup support to other team members, ensuring that the workflow remains uninterrupted. This role is ideal for someone who thrives in a fast-paced and dynamic work environment, where proactive problem-solving and adaptability are key. You will be part of a team that is dedicated to making a difference in the lives of our members by ensuring they receive the medicine they need to feel better and live well.