Machinify - Pharmacy High-Cost Drug Analyst

• Investigates to confirm that drug claims are billed and paid correctly • Analyzes claims data and healthcare records, applying specialized knowledge of prescription drugs, provider practices, and health insurance benefit structure • Communicates with healthcare providers and insurers to gather required information • Utilizes all available resources to maximize identification and recovery of overpayments • Answers phone calls in a timely fashion and resolves issues • Creates, maintains, and closes files in accordance with policies and guidelines • Assists with submitting overpaid claims in client vendor management systems, as needed • What experience you bring (Role Requirements) • Bachelor’s Degree or equivalent combination of experience in health insurance or related fields, which would provide the necessary knowledge, skills and abilities to successfully perform the work • Medical claim billing and/or coding experience is extremely valuable, but not required • Experience in the pharmaceutical field is helpful, but not required. • Professional oral and written communication skills, including excellent phone communication skills • Comfortable working in computer applications • Very strong critical thinking, attention to detail, and organizational skills • Ability to work well independently or in a team environment • Proficiency with Microsoft Word and Excel • What Success Looks Like… • You will have a strong understanding of the role. • You begin building relationships and collaborating with peers. • You develop effective time and priorities management. • You receive initial feedback about your performance and are using it to improve. • You’ve gained confidence in your abilities and are starting to feel more comfortable in your role. • You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency. • You have established a strong network of internal relationships and are recognized as a key collaborator. • You’ve been entrusted with greater responsibility indicating the company’s confidence in your abilities. • You see opportunities for career progression and personal development.