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Pharmacy Claims Jobs (NOW HIRING)

Onco360

$23/hr

The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of ...

PharMerica

Pharmacy Claims Processor / Remote

Louisville, KY · Remote

$15.50 - $19.75/hr

Our Company PharMerica Overview Step Into a Rewarding Role as an LTC Pharmacy Claims Specialist with PharMerica! Are you ready to make a real impact in a growing organization? Join our PharMerica ...

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How much do pharmacy claims jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for pharmacy claims in the United States is $29.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.10 per hour, depending on experience, location, and employer.

What are some common challenges faced in a pharmacy claims role and how are they managed?

One common challenge in Pharmacy Claims is navigating complex insurance policies and resolving claim denials, which requires close attention to detail and a good grasp of industry guidelines. Professionals in this field frequently interact with pharmacists, healthcare providers, and insurance representatives to clarify coverage issues and expedite claim approvals. Staying up-to-date on changes in reimbursement policies and regulations is essential to avoid processing errors. Many employers offer ongoing training and support to help Pharmacy Claims specialists manage these challenges efficiently and maintain high-quality service.

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

To thrive in Pharmacy Claims, you need a solid understanding of pharmacy benefit management, medical terminology, and claims processing, often supported by experience in healthcare or a related certification such as Pharmacy Technician Certification (CPhT). Familiarity with claims adjudication software, pharmacy management systems, and insurance platforms is typically required. Strong attention to detail, problem-solving skills, and clear communication abilities distinguish top performers in this field. These skills ensure accuracy, timely resolution of claims, and effective collaboration with pharmacists, insurers, and patients.

What is a pharmacy claims?

A Pharmacy Claims job involves processing, reviewing, and resolving insurance claims related to prescription medications. Professionals in this role work with pharmacies, insurance providers, and patients to ensure claims are accurately submitted and reimbursed. Responsibilities may include verifying patient eligibility, troubleshooting rejected claims, and ensuring compliance with insurance policies. Strong attention to detail and knowledge of pharmacy billing codes are essential for success in this field.

More about Pharmacy Claims jobs
What cities are hiring for Pharmacy Claims jobs? Cities with the most Pharmacy Claims job openings:
What are the most commonly searched types of Pharmacy Claims jobs? The most popular types of Pharmacy Claims jobs are:
What states have the most Pharmacy Claims jobs? States with the most job openings for Pharmacy Claims jobs include:
What job categories do people searching Pharmacy Claims jobs look for? The top searched job categories for Pharmacy Claims jobs are:
Pharmacy Claims jobs near you
Infographic showing various Pharmacy Claims job openings in the United States as of August 2026, with employment types broken down into 85% Full Time, and 15% Part Time. Highlights an 69% In-person, and 31% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

Pharmacy Claims Adjudication Specialist

Onco360

Houston, TX

$21/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 11 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

21st of 112 rated pharmacies

Job description

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, with a hybrid work style.
Shift times 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 $21.00 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
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Employment Type: Full Time

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