Claims Examiner

Job Title: Claims Examiner

Location: Remote, Work-From-Home

Reports To: SR. Manager, Operations

Join us in powering the future of pharmacy cost containment!

HelpScript, LLC, an Expion Health Company, has an exciting opportunity for a Claims Examiner in our HelpScript organization. Our team is continuously expanding the boundaries of the healthcare industry through innovations that intersect data and technology and amplifies human intelligence to result in better outcomes. We need people like you to join in our commitment to drive pure exponential value for our clients and partners.

Are you up for the challenge?

Position Summary

The Claims Examiner is responsible for accurately reviewing, processing, and adjudicating claims related to specialty medications, with a focus on applying manufacturer copay assistance and ensuring benefit coordination. This role ensures compliance with payer guidelines, client requirements, and internal policies while maintaining a high level of accuracy and timeliness.

Competencies

Deliver & Execute (70%) – Demonstrates precision and accountability in processing healthcare claims by consistently meeting accuracy and turnaround standards. Applies policies, copay assistance rules, and benefit coordination with efficiency to ensure timely and compliant claim outcomes.

Learn & Grow (15%) – Actively seeks opportunities to expand knowledge of healthcare claims, payer policies, and copay assistance programs. Embraces feedback and evolving industry standards to improve accuracy, efficiency, and professional development.

Plan & Align (15%) – Effectively prioritizes claim workloads and aligns processing activities with organizational timelines, payer requirements, and program goals. Demonstrates foresight in coordinating resources and maintaining compliance to ensure consistent, high-quality claim outcomes.

Essential Functions

Review and adjudicate specialty drug claims submitted to HelpScript

Investigate and resolve claim discrepancies, denials, or incomplete submissions

Maintain accurate documentation of claim decisions and processing steps in the system

Monitor claim turnaround times and escalate issues that may impact service levels

Stay current on payer policies, copay program updates, and specialty drug guidelines

Support audits, quality assurance reviews, and compliance initiatives

Collaborate with cross-functional teams including patient advocate teams and leadership

Required Expertise

High school diploma or equivalent required; associate or bachelor's degree preferred

1 - 3 years of experience in healthcare claims processing, medical billing, or insurance adjudication

Familiarity with healthcare terminology, specialty medication, coding systems, and insurance benefit structures

Strong analytical skills and attention to detail

Excellent written and verbal communication skills

Proficiency in claims processing software and Microsoft Office Suite

Understanding of HIPAA regulations

Ability to work independently in a remote environment and manage time effectively

Perform other related duties as assigned to support departmental goals, operational needs, or organizational initiatives

Preferred Skills

Experience with payer portals, EDI systems, or clearinghouses

Understanding of coordination of benefits and prior authorization workflows

Ability to interpret explanation of benefits (EOBs) and remittance advice

Position Type, Work Location & Travel

Position Type: This is a full-time hourly position.

Work Location: This is a remote, work-from-home position.

Travel: Occasional travel may be required for meetings, training, or company events. Travel is typically planned in advance and reimbursed according to company policy.

What It's Like to Work with Us

Expion Health has been challenging the industry status quo for over 30 years, leading with ground-breaking innovation in a wide variety of healthcare solutions. Embracing the latest opportunities that technology can offer within a rapidly evolving industry, we provide exceptional service, technology, and product innovation to meet greater challenges in pharmacy and medical cost management.

We have a distributed workforce so you can work from anywhere in the continental United States. Because of our distributed nature, we have cultivated a connected culture that includes town halls, one-on-ones with executive leadership, educational forums, and even social clubs.

We offer comprehensive benefits package which includes the following:

Medical, dental, and vision insurance

Short-term and long-term disability

Life insurance and AD&D

GLP-1 Weight loss

Supplemental life insurance (Employee/Spouse/Child)

Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

Healthcare and dependent care Flexible Spending Accounts

Healthcare Savings Account

401(k) Savings and Investment Plan with company match

Paid time off

Phone and Internet allowance

Expion Health is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.