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Pharmacy Claim Manager Jobs (NOW HIRING)

NRECA

Sr Specialist, Pharmacy Claims

Lincoln, NE · On-site

$68K - $80K/yr

Troubleshoot pharmacy claim issues * Answer questions from members and providers. * Work with ... Knowledge of pharmacy benefit management (PBM), including benefit design, coverage limitations, and ...

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Pharmacy Claim Manager information

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$35K

$87.9K

$139K

How much do pharmacy claim manager jobs pay per year?

As of Sep 12, 2026, the average yearly pay for pharmacy claim manager in the United States is $87,861.00, according to ZipRecruiter salary data. Most workers in this role earn between $68,000.00 and $105,000.00 per year, depending on experience, location, and employer.

What are popular job titles related to Pharmacy Claim Manager jobs?

For Pharmacy Claim Manager jobs, the most frequently searched job titles are:

Infographic showing various Pharmacy Claim Manager job openings in the United States as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 80% Physical, 2% Hybrid, and 18% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.

Pharmacy/Billing Technician

Franklin, TN • On-site

American Health Partners
Health Care and Social Assistance • 1 - 5K employees
Learn more about American Health Partnersexternal

$17 - $20.50/hr

Full-time

Posted 24 days ago

Job description

JOB SUMMARY:The Pharmacy Technician for American Health Plans is responsible for activities related to member access in the area of claims adjudication appropriateness and operations performed by the Plan's Pharmacy Benefit Manager for a Medicare Advantage Institutional Special Needs Plan (I-SNP).
ESSENTIAL JOB DUTIES:
To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation.
  • Review daily point-of-service (POS) pharmacy claims, resolve actionable items, track, and provide reporting
  • Investigate and resolve pharmacy claim rejections, reversals, and payment discrepancies in real time.
  • Collaborate with external pharmacy and claims teams to ensure accurate claim adjudication and payment.
  • Submit and track claim overrides when appropriate and compliant with plan and CMS guidelines.
  • Ensure proper coordination of benefits (COB), hospice billing considerations, and Part A/B vs Part D determinations when applicable.
  • Facilitate the prior authorization process by working with prescribers, pharmacies, and internal clinical staff.
  • Gather and submit required documentation for PA review and ensure completeness to minimize delays.
  • Monitor PA status and proactively communicate determinations and next steps to pharmacies and providers.
  • Serve as primary billing and claims contact for contracted network and long-term care pharmacies.
  • Communicate professionally with pharmacy billing teams, prescribers, and facility staff to resolve claims issues.
  • Educate pharmacies and provider offices on billing requirements, formulary limitations, and plan processes.
  • Support transitions of care by ensuring medication access and clean claim processing for new or discharged members.
  • Maintain compliance with CMS Medicare Part D regulations, HIPAA, and plan policies.
  • Accurately document all claim interventions, communications, and resolutions in the plan's system.
  • Assist with internal audits, reporting, and quality improvement initiatives related to claims and billing.
  • Identify trends in claim rejections or PA delays and escalate systemic issues to leadership.
  • Monitor daily billing and claims work queues and meet productivity and turnaround time expectations.
  • Participate in cross-functional meetings with pharmacy operations, clinical, and provider relations teams.
  • Support process improvement initiatives to enhance claims efficiency and member access to medications.
  • Serve as a liaison with Enrollment Department to assure appropriate member eligibility processing
  • Recognize formulary requirements: prior authorization (PA), Step Therapy (ST), Quantity Limit (QL) and understand NCPDP reject codes
  • Coordinate clinical reporting
  • Follow-up and solve open items in a timely manner
  • May be assigned to work on special projects and business initiatives
  • Other duties as assigned

JOB REQUIREMENTS:
  • Proficient with Microsoft Suite applications
  • Ability to navigate multiple systems
  • Strong analytical skills
  • Proficient communication and presentation skills
  • Adhere to Centers of Medicare and Medicaid Services (CMS) regulations and compliance requirements
  • Successful completion of required training

REQUIRED QUALIFICATIONS:
  • Education:
    • High school diploma or equivalent
  • Experience:
    • Minimum of 2 years as a Pharmacy technician, long term care, or health plan experience
    • Experience in planning and implementation
    • Experience working pharmacy claims, rejections, and PA's
  • License/Certification(s):
    • Pharmacy Technician certification preferred

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
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About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

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