Benefits Specialist

Pharmacy Benefits Specialist

6 months contract to hire | Pittsburgh, PA | Boise, ID Oxford Solutions has an opening for a Pharmacy Benefits Specialist to join our client's growing team. In this role, you will process pharmacy claims, research insurance coverage, and collaborate with internal teams to ensure patients receive timely and accurate support.

Responsibilities

• Accurately process claims in compliance with program guidelines and client expectations
• Review and resolve rejected claims, researching patient pharmacy benefit coverage and eligibility
• Maintain compliance with patient assistance program requirements and all State and Federal regulations
• Research and document claim and benefit issues using available systems and resources
• Communicate effectively with patients, providers, and internal teams to resolve issues
• Protect the confidentiality of all patient and proprietary information
• Partner with management, compliance, and the pharmacy team to improve accuracy and workflow efficiency

Requirements

• High school diploma or GED required; Bachelor's degree preferred
• At least 1 year of medical or pharmacy benefits experience, including third-party claims resolution
• Strong working knowledge of benefit coordination, copay assistance programs, and insurance plan structures
• Understanding of Medicare Parts A, B, and D, Medicare Advantage plans, and coordination of benefits processes
• Excellent communication skills and attention to detail
• Ability to work independently and as part of a team in a fast-paced environment

Schedule & Location

Full-time, onsite roles available in Pittsburgh, PA (Robinson) or Boise, ID Shifts vary between 8 AM and 9 PM EST, Monday through Friday, with occasional rotating Saturday shifts (9 AM – 5 PM). Flexibility is required, as schedules may change based on business needs.