Copay Claims Processor

Description

Join Us at TailorMed – Transforming Healthcare Affordability

At TailorMed , we’re on a mission to eliminate barriers across the entire medication journey—from affordability to access and adherence. As a pioneering force in healthcare, we’re building a new category that transforms how patients, providers, pharmacies, life sciences, and payers collaborate to ensure every patient receives the treatment they need without delay.

Our enterprise solution streamlines the full lifecycle of patient support programs, reducing the cost of care and driving better outcomes. With the nation's largest Affordability Network —deployed across 800+ hospitals, 1,300 clinics, and 650 pharmacies —we’re reshaping healthcare with innovative automation and industry-leading partnerships.

If you’re passionate about making healthcare more accessible and impactful, we’d love to have you on our team. Join us and help redefine what’s possible. Learn more at .

The Copay Claims Processor is a member of the TailorMed Complete team and serves as an extension of our customer’s internal teams. In this role, you'll help improve financial outcomes for patients by using our platform to submit claims on the patient’s and provider’s behalf to the approved manufacturer or foundation copay program, and for our customers by helping them improve their financial performance as an organization.

Responsibilities:

• Ability to review pending claims thoroughly in detail to ensure accuracy
• Submit copay claims through appropriate channels, including follow through to payment posting
• Conduct timely follow up to check for claims status
• Work closely with the Financial Navigation team to ensure accurate and timely processing of claims
• Claim denial review and understanding in how to evaluate for next steps
• Conduct outbound calls with manufacturer copay programs and foundation copay programs to resolve any issues or discrepancies
• Conduct outbound calls effectively with customer’s revenue cycle department to resolve any issues or discrepancies
• Post claim payments accurately and appropriately as received
• Maintain accurate records of all claims processed
• Meet productivity and quality standards

Requirements:

• 2+ years of experience in medical billing and coding, or financial navigation experience
• Ability to work effectively in a remote environment

Experience working within EMRs and Billing Systems

• Experience working with insurance providers and healthcare organizations
• Knowledge of all insurance types
• Excellent communication and organizational skills
• Ability to work well in a fast-paced environment
• Willingness to adhere to and work during customer’s business hours
• High school diploma or equivalent required
• Workspace clear of noise and ability to work with PHI in a secure setting

What we offer:

• Competitive salary + equity
• Premium medical, dental, and vision insurance plans, a wide range of voluntary and supplemental benefits, and 24/7 benefits access and support
• 401(k) plan
• Paid holidays, vacation, and sick leave
• Six weeks of paid parental leave
• Company-paid life insurance
• Company provided equipment and technology you’ll need to be successful in your role

The opportunity to help shape the future of healthcare

TailorMed is proud to be an equal opportunity employer. TailorMed prohibits discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Due to the sensitive nature of the data that TailorMed handles, finalist candidates must complete a successful background and reference check.

At this time, TailorMed is unable to provide sponsorship for employment. In order to be considered for employment, applicants must be currently legally authorized to work in the United States and not require future sponsorship in order to continue working in the United States.

Originally posted on Himalayas