Pharmacy Claims Adjudication Specialist
$21 per hourOnco360
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 October 31st, 2026. We offer a variety of benefits including:
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...
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 October 31st, 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
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.
- 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
Vacancy posted 9 days ago
Similar jobs that could be interesting for youBased on the Pharmacy Claims Adjudication Specialist in Houston, TX vacancy
- Texas Children’s Health Plan is seeking a Claims Examiner to process and adjudicate claims for reimbursement to providers based on established procedures. You will review and research claims, ensuring adherence to guidelines and timeliness. Ideal candidates have a high...Suggested
$60.6k - $95.7k
...Management Liability Claims Specialist IAT Insurance Group has an immediate opening for a Management Liability Claims Specialist that can be located in any of our IAT locations. This role works a hybrid schedule from an IAT Office. The hybrid schedule reflects our...SuggestedWork at officeImmediate startRemote workVisa sponsorshipIAT Insurance Group
Houston, TX2 days ago- ...A leading automotive service provider in Houston is looking for a Warranty Administrator to manage and process warranty claims ensuring compliance with manufacturer policies. This role requires strong organizational skills, attention to detail, and effective collaboration...SuggestedWork at office
Ztautogroup
Houston, TX4 days ago - ...sharing ideas. Join in on the excitement and become part of our thriving organization! We are seeking an experienced Casualty Claims Specialist! The Casualty Claims Specialist will be responsible for investigating and settlement of automobile bodily injury claims....SuggestedFull timeWork at office
First Chicago Insurance Company
Houston, TX4 days ago - ...Claims Examiner We are looking for a Claims Examiner, someone who's ready to grow with... ...In this position, you will process and adjudicate claims received for reimbursement to... ...than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health...SuggestedHourly payFull timeLocal areaShift work
- ...Warranty Claims Coordinator Houston, Texas, United States The Warranty Claims Coordinator is responsible for managing the end-to-end warranty claims process for ON.energy's data center projects across Texas. This role serves as the primary liaison between field...Contract workFor contractorsWork at officeLocal area
- ...Job Description Job Description Position Summary The Warranty Claims Specialist administers product warranty claims from initial intake through resolution. The position reviews claim documentation, evaluates information against applicable warranties and installation...For contractors
Elementia
Houston, TX2 days ago - Log and respond to all incoming cargo claims through the claims management system Report appropriate claims to the insurance carrier in a timely manner Develop action plans to move claims to resolution Responsible for the adjustment and handling of all cargo liability...Work at officeWorldwide
- ...sharing ideas. Join in on the excitement and become part of our thriving organization! We are seeking an experienced Casualty Claims Specialist! The Casualty Claims Specialist will be responsible for investigating and settlement of automobile bodily injury claims. They...Work at office
- ...accommodation or an alternative application process. Entry Level Claims Examiner (Dental, Vision & Hearing) FT Hourly Full-Time... ...documentation received and provide timely follow-ups for claims being adjudicated. Process and resolve insurance claims in accordance to claim...Hourly payFull timeContract workTemporary workWork at officeImmediate startFlexible hours
- ...Help homeowners navigate the insurance claims process after storm damage, providing guidance and support every step of the way. In this role, you’ll work closely with clients, insurance adjusters, and internal teams to ensure claims are handled efficiently, accurately...
Apollo Roofing
Houston, TX3 days ago - Join Starr, a global leader in commercial insurance with over a century of expertise. We empower our employees to innovate, make impactful decisions, and build lasting client relationships worldwide. At Starr, you'll work in an entrepreneurial culture alongside accessible...Full timeWorldwide
- ...Monitor portfolio performance by tracking exposure limits, premium income, and overall financial results, while maintaining awareness of claims activity and providing underwriting input on claim resolution.Support business planning, forecasting, and underwriting governance...Full timeTemporary work
$135k - $150k
Join Starr, a global leader in commercial insurance with over a century of expertise. We empower our employees to innovate, make impactful decisions, and build lasting client relationships worldwide. At Starr, you'll work in an entrepreneurial culture alongside accessible...Full timeWork at officeWorldwideHome office- ...related issues.Deep understanding of commercial insurance practices and regulations to analyze risk eligibility, evaluate prior incurred claims, and make appropriate risk-based decisions using sound underwriting judgement.Demonstrate successful agency and broker management,...Live in
- Join Starr, a global leader in commercial insurance with over a century of expertise. We empower our employees to innovate, make impactful decisions, and build lasting client relationships worldwide. At Starr, you'll work in an entrepreneurial culture alongside accessible...Full timeWork at officeWorldwide
$87.1k - $181.4k
...Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We’re all about people | We win together | We strive for better We enjoy the...Full timeWork at officeLocal areaWork from homeFlexible hours$86.25k - $172.5k
Job ID: R233468Posted: 2026-08-24Location: PA - Pittsburgh (15222); IL - Chicago; OH - Cincinnati; TX - Dallas; TX - HoustonSalary: $86,250.00 - $172,500.00Type: Full timeCountry: United States of AmericaCompany: PNCPosition OverviewAt PNC, our people are our greatest differentiator...Full timeTemporary workPart timeWork experience placementWork at office- DescriptionThis position must be onsite and is available to be filled at any Huntington Corporate office location.Summary:Underwrite residential first mortgage and/or Home Equity loan applications received from mortgage loan originators, bankers and/or mortgage brokers ...Full timeSelf employmentH1bWork at officeRemote workFlexible hours
$86.25k - $143.75k
Job ID: R228123Posted: 2026-09-01Location: Home Location-OH (OHH01); PA - Philadelphia; OH - Brecksville; OH - Cleveland; TX - HoustonSalary: $86,250.00 - $143,750.00Type: Full timeCountry: United States of AmericaCompany: PNCPosition OverviewAt PNC, our people are our ...Full timeTemporary workPart timeWork experience placementWork at officeRemote workWork from home$94.45k - $160.34k
...products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned... ...and productive relationships with professional liability specialist brokers in the Central U.S., marketplace. Demonstrated strong...Full timeWork at officeLocal area- External Applicants: Please apply through Prosperity Bank's Career Center at . Applying through any other source may prevent Prosperity from receiving your application. Internal Applicants: If you are a current associate of Prosperity Bank, please apply through the internal...Full timeWork at officeMonday to Friday
- Zions Bancorporation is one of the nation’s premier financial services companies operating as a collection of great banks under local brands and management teams in high-growth western markets. Zions is regularly recognized by American Banker magazine as having a top banking...For contractorsLocal areaFlexible hours
$74.05k - $121.99k
...products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.Job DescriptionThis...Full timeWork at officeLocal area$150k - $250k
...) and customers; analyzing risk and exercising judgment to offer appropriate policy terms; evaluating due diligence and managing specialist advisors to assist as necessary; reviewing and negotiating transaction agreements and policy documentation; and proactively responding...Temporary workFlexible hours$124k - $199.8k
...business without sacrificing quality.Program ManagementParticipation in all aspects of program management such as actuarial pricing, claim or TPA oversight, reinsurance accounting and collateral management.Possesses a deep understanding of the business.Demonstrated...Full timeTemporary workWork at office3 days per week- With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short...Full timeTemporary workWork at office
$75k - $137.5k
Job ID: R233729Posted: 2026-08-28Location: PNC Dallas (TX135); TX - HoustonSalary: $75,000.00 - $137,500.00Type: Full timeCountry: United States of AmericaCompany: PNCPosition OverviewAt PNC, our people are our greatest differentiator and competitive advantage in the markets...Full timeTemporary workPart timeWork experience placementWork at office$100k - $125k
Who We AreJoin a team that puts its People First! First American's Direct division provides comprehensive title insurance protection and professional settlement services for real estate purchases, refinances and equity loans. Since 1889, First American (NYSE: FAF) has held...Full time- ...targets.Negotiate price and terms and conditions with producer.Specialist / Technical Expert in Product Line within Middle Market Business... ...areas in Underwriting process, including e.g. MMC, ARC, Claims, Operations.Required Skills and Abilities:Risk Assessment and Management...Full timeContract workTemporary workLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Pharmacy Claims Adjudication Specialist. Be the first to apply!
Related searches
- pharmacy specialist Houston, TX
- claims assistant Houston, TX
- claims processor Houston, TX
- claims resolution specialist Houston, TX
- claim representative (remote) Houston, TX
- claim specialist Houston, TX
- claims analyst Houston, TX
- medical claims analyst Houston, TX
- insurance claims processor Houston, TX
- remote medical claims processor Houston, TX