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What are the key skills and qualifications needed to thrive as a Disability Adjudicator (Remote), and why are they important?

To thrive as a Disability Adjudicator, you need a strong understanding of medical terminology, case evaluation, and disability regulations, typically supported by a relevant degree or experience in healthcare, social services, or claims processing. Familiarity with case management software, electronic claims systems, and government disability guidelines is essential. Attention to detail, critical thinking, and effective communication are vital soft skills for assessing complex cases and interacting with claimants. These abilities ensure accurate, fair, and timely determinations that uphold program integrity and support those in need.

What are some typical challenges faced by remote Disability Adjudicators, and how can they be managed effectively?

Remote Disability Adjudicators often face challenges such as interpreting complex medical documentation without in-person consultations, maintaining effective communication with claimants and medical professionals, and managing a high volume of cases independently. To manage these challenges, adjudicators rely on secure digital platforms for document review, participate in regular virtual meetings for case discussions, and follow structured workflows to stay organized. Building strong time management skills and staying proactive in seeking clarification from colleagues or supervisors can also help ensure accuracy and efficiency in their work.

What are Disability Adjudicators?

Disability Adjudicators are professionals who review and evaluate claims for disability benefits, typically for government agencies such as Social Security or state disability programs. They assess medical and vocational evidence to determine whether applicants meet the criteria for disability. Working remotely, they communicate with medical professionals, claimants, and sometimes conduct interviews or request additional documentation. Their role is crucial in ensuring that disability decisions are fair, consistent, and in line with established guidelines.
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Disability Adjudicator Remote jobs near you
Infographic showing various Disability Adjudicator Remote job openings in Arizona as of July 2026, with employment types broken down into 2% As Needed, 96% Full Time, and 2% Contract. Highlights an 100% Remote job distribution.
Pharmacy Claims Adjudication Specialist

Pharmacy Claims Adjudication Specialist

Onco360

Scottsdale, AZ • Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 24 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 109 rated pharmacies

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Scottsdale, AZ. This will be a Full-Time position. This is a remote hybrid opportunity, after onsite training period.
Shift time between 8am and 8pm.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Starting salary from $23.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before August 31, 2026.
We offer a variety of benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits – life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities:
The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
Pharmacy Adjudication Specialists at Onco360...
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
  • Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
  • Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
  • Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
  • Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
  • Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
  • Documents and submit requests for Patient Refunds when appropriate.
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
    • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
  • Work Experience
    • Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
    • Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
  • Skills/Knowledge
    • Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
    • Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
  • Licenses/Certifications
    • Required: Registration with Board of Pharmacy as required by state law
    • Desired: Certified Pharmacy Technician (PTCB)
  • Behavior Competencies
    • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
#Company Values: Teamwork, Respect, Integrity, Passion
#IH

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