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Pharmacy Adjudication Jobs (NOW HIRING)

Onco360

$23/hr

W e 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.

Onco360

$21/hr

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Louisville, KY. This will be a Full-Time position. This position must be located within driving distance to our ...

Onco360

$21/hr

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Houston, TX. This will be a Full-Time position. This position must be located within driving distance to our pharmacy ...

Onco360

$21/hr

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Houston, TX. This will be a Full-Time position. This position must be located within driving distance to our pharmacy ...

Onco360

$23/hr

W e 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.

Elevance Health

Pharmacy Technician

Fort Worth, TX

$16.75 - $20.25/hr

Utilizes pharmacy's adjudication platform, to enter required information in order to record all legal requirements for preparation of prescription verification by Pharmacist. * Maintain compliance ...

Elevance Health

Pharmacy Technician

Fort Worth, TX · On-site

$16.75 - $20.25/hr

Utilizes pharmacy's adjudication platform, to enter required information in order to record all legal requirements for preparation of prescription verification by Pharmacist. * Maintain compliance ...

Elevance Health

Pharmacy Technician

Richardson, TX · On-site

$16 - $19.25/hr

Utilizes pharmacy's adjudication platform, to enter required information in order to record all legal requirements for preparation of prescription verification by Pharmacist. * Maintain compliance ...

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How much do pharmacy adjudication jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for pharmacy adjudication in the United States is $19.27, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $20.43 per hour, depending on experience, location, and employer.

What is pharmacy adjudication?

A Pharmacy Adjudication job involves processing and verifying prescription claims for insurance coverage. Professionals in this role ensure that prescriptions meet plan requirements, confirm patient eligibility, and determine costs based on the policy. They work closely with pharmacies, insurance companies, and healthcare providers to resolve billing issues and denials. Strong attention to detail and knowledge of insurance policies are essential for success in this role.

What are the primary responsibilities of someone working in pharmacy adjudication?

Professionals in pharmacy adjudication are responsible for reviewing, processing, and resolving pharmacy claims to ensure accuracy and compliance with insurance and regulatory guidelines. Their daily tasks typically involve verifying patient and prescription information, checking for eligibility and coverage, and investigating any claim discrepancies or rejections. They frequently collaborate with pharmacists, insurance representatives, and patients to resolve issues and facilitate the reimbursement process. This role requires balancing technical expertise with strong communication skills to provide efficient, reliable service in a detail-oriented environment.

What are the key skills and qualifications needed to thrive in pharmacy adjudication, and why are they important?

To thrive in pharmacy adjudication, you need keen attention to detail, strong analytical abilities, and knowledge of pharmacy benefit management, insurance claims, and healthcare billing, often supported by a relevant associate degree or experience in the field. Familiarity with pharmacy claims processing systems, pharmacy management software, and common coding standards like NCPDP is highly valued. Excellent problem-solving skills, effective communication, and the ability to handle sensitive information professionally are important soft skills in this role. These competencies ensure accurate claims review, efficient coordination with pharmacies and insurers, and high-quality customer service.

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Pharmacy Adjudication jobs near you
Infographic showing various Pharmacy Adjudication job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 69% Full Time, 28% Part Time, and 2% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $40,074 per year, or $19.3 per hour.

Pharmacy Claims Adjudication Specialist

Onco360

Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 3 days ago. Applications are no longer accepted.

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 113 rated pharmacies

Job description

W e 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 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.
  • 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 Employment Type: Full Time

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