Pharmaceutical Claims Processor

Join the DATAMARK, Inc. Team as a Medical Claims Processor!

Are you looking for an exciting opportunity where your attention to detail and problem-solving skills make a real impact? Do you thrive in an environment that requires critical thinking and strong judgment? If so, we have the perfect role for you! As aMedical Claims Processorat DATAMARK, you'll play a vital role in the success of our operations by ensuring accurate and efficient back-office support.

We are seeking a detail-oriented and performance-driven Medical Claims Processor to support patients prescribed complex and high-cost drug therapies. In this role, you will be responsible for verifying insurance coverage, conducting research, and resolving coverage-related issues to ensure timely and accurate prescription processing.

This is a back-office position that requires strong analytical skills, efficiency, and comfort with outbound calls to insurance providers and patients.

• Verify insurance coverage for new and existing patients to support timely prescription fulfillment
• Pull and review customer accounts to assess eligibility, benefits, and coverage limitations
• Conduct detailed research across multiple systems and portals
• Initiate and complete outbound calls (OB calls) to insurance companies, pharmacies, and other partners to resolve coverage issues
• Accurately document findings, decisions, and next steps in internal systems
• Meet or exceed productivity expectations while maintaining accuracy
• Identify and escalate complex cases or discrepancies as appropriate
• Support patients requiring specialty, high-cost, or complex therapies through thorough and timely insurance determination

Requirements

• Previous experience in insurance verification, benefits investigation, pharmacy operations, or healthcare administration preferred
• Knowledge of medical insurance terminology (deductibles, copays, prior authorizations, etc.)
• Excellent reading comprehension and research abilities
• Comfortable making outbound calls to resolve insurance or coverage-related issues
• Strong problem-solving and critical-thinking skills
• Ability to manage productivity metrics in a fast-paced environment
• Basic computer proficiency and experience navigating multiple systems

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, IRA)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off
• Sign-on Retention Bonus: $500 after completion of training/OJT/Nesting, 1 week of production, and adhering to attendance policy.
• Production Incentive: Additional pay per hour based on productivity goals and expectations.
• WAH / Remote possible after Classroom Training/OJT/Nesting based on performance
• Short Term & Long Term Disability
• Training & Development
• Wellness Resources
• $16.50 per hour