Pharmacy Technician PrideStaff St. Pete/Clearwater - 3.9 Clearwater, FL Job Details Full-time From $24.50 an hour 1 day ago Benefits Health insurance 401(k) Paid time off Prescription drug insurance Qualifications Customer communication Medicare Underwriting Health insurance policy knowledge Research Attention to detail Insurance (Financial sectors) Medical terminology Full Job Description We are seeking a decisive and detail-oriented professional with a strong background in prescription drug insurance and Medicare claims to join our team as a public-facing Underwriter. This is not a "back-office" data entry role; you will be the primary decision-maker responsible for making critical daily determinations on policy underwriting. If you possess a deep understanding of medical insurance contracts and enjoy a fast-paced environment where your expertise directly impacts policyholders, this is your next career move.

Duties and Responsibilities:

Underwriting & Adjudication:

Make high-level decisions necessary to properly adjudicate medical and prescription claims and respond to complex written inquiries.

Claims Investigation:

Examine, investigate, and research medical insurance claims to ensure accuracy and compliance.

Liability Analysis:

Analyze claims to determine the extent of insurance carrier liability while interpreting specific contract benefits.

Process Management:

Efficiently process claims from inception to final determination, ensuring all regulatory standards are met.

Client Communication:

Serve in a public-facing capacity to articulate determinations and provide clarity on policy underwriting.

Experience and Qualifications:

Industry Experience:

Minimum of 1 year of experience in medical insurance is required.

Medicare Expertise:

Previous experience with Health, Medicare, or Prescription (Rx) claims adjudication.

Medicare Supplement experience is strongly preferred.

Technical Proficiency:

Strong familiarity with medical terminology, procedure codes, and diagnosis codes.

Billing Knowledge:

Direct experience with UB/Institutional and HCFA/Professional billing forms.

Financial Literacy:

Proven ability to accurately interpret and explain Explanations of Benefits (EOBs).

Decision-Making:

A proven track record of making critical, high-stakes determinations in a professional setting. #IND450

B Pay:

From $24.50 per hour

Benefits:

401(k) Health insurance Paid time off

Work Location:

In person