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Pbm Claims Adjudication Software Jobs (NOW HIRING)

Moda Health

RX Prior Authorization Coord I

Portland, OR · On-site

$21.30 - $23.96/hr

Must be able and willing to learn a third-party real-time interactive PBM claims adjudication system, where great attention to detail is imperative. * Ability to gain proficiency in Moda internal ...

Johns Hopkins Healthcare

Vendor Auditor

Hanover, MD · On-site

The Vendor Auditor analyzes medical, pharmacy, and PBM claims data to assess payment accuracy ... The ideal candidate possesses advanced knowledge of claims adjudication, Medicare and Medicaid ...

APS Health Care PR

PR · On-site

$16.75 - $20.25/hr

... PBM claims processing system to ensure that claims are correctly adjudicated. 5. Assists pharmacies claim processing. 6. Assist in the training of pharmacy representatives. 7. Complies with all ...

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How much do pbm claims adjudication software jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for pbm claims adjudication software in the United States is $21.05, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $22.84 per hour, depending on experience, location, and employer.
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Pbm Claims Adjudication Software jobs near you
Infographic showing various Pbm Claims Adjudication Software job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 87% Full Time, 8% Part Time, and 4% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $43,783 per year, or $21 per hour.

Pharmacy Claims Adjudication Specialist

Onco360

Denver, CO • Remote

$24/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 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 112 rated pharmacies

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy working in Mountain Time Zone. This will be a Full-Time position. This is a remote/hybrid opportunity,
Shift times start at 10am Mountain Time Zone until 8pm Mountain Time Zone.
Full-Time position may work remotely but MUST HAVE ACTIVE COLORADO PHARMACY TECHNICIAN credentials from the State Board of Pharmacy.
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 $24.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before September 30th, 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.
  • Documenst 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

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