Pharmacy Claims Specialist
Pay: $21.00/hour
About the Role
We are seeking detail-oriented and patient-focused individuals to join our growing health-tech team as a Pharmacy Claims Specialist. In this role, you will play a critical part in ensuring patients receive timely access to medications by processing pharmacy claims, resolving insurance issues, and supporting patient assistance programs.
This is a great opportunity to join an innovative organization that is transforming the pharmacy and healthcare space while offering strong growth potential and a collaborative culture.
Key Responsibilities
- Process pharmacy claims accurately and efficiently to meet client expectations
- Triage and resolve rejected pharmacy insurance claims by verifying patient benefits coverage
- Ensure compliance with patient assistance program guidelines
- Document all findings and actions according to standard operating procedures
- Research and gather necessary information using available tools and resources
- Maintain strict confidentiality of patient and proprietary information
- Perform all duties in compliance with corporate policies and State/Federal regulations
- Collaborate cross-functionally with teams including pharmacy, compliance, engineering, and leadership
Ideal Candidate Background
We are looking for candidates with strong communication skills and exposure to healthcare or pharmacy-related processes, such as:
- Pharmacy claims, insurance verification, or prior authorization
- Pharmacy technician experience (retail, specialty, or hospital)
- Administrative experience within pharmacy, healthcare, PBMs, or health plans
- Experience in related healthcare fields (DME, oncology, or patient support services)
Note: We value high-potential candidates with strong interpersonal skills and a willingness to learn just as much as direct experience.
What Makes You a Great Fit
- Strong verbal and written communication skills
- Analytical mindset with attention to detail and sound judgment
- Passion for delivering excellent patient care
- Ability to work collaboratively across teams
- Strong technical aptitude and ability to learn new systems quickly
Schedule & Training
Department Hours:
- Monday – Friday: 8:00 AM – 9:00 PM EST
- Saturday: 9:00 AM – 5:00 PM EST
Training:
- 4–6 weeks
- Monday – Friday, 10:00 AM – 6:00 PM EST
Schedule Options:
Consistent Schedule:
- 12:00 PM – 8:30 PM EST
- OR 12:30 PM – 9:00 PM EST
Rotational Schedule:
- Mix of early, mid, and closing shifts
Example Rotation:
- 1 Closing Shift (12:00–8:30 or 1:00–9:30)
- 1 Mid Shift (11:00–7:30)
- 3 Early Shifts (9:00–5:30 or 10:00–6:30)
- One Saturday per month required (with a weekday off)
- Schedules provided approximately one month in advance
Why Join Us?
- Be part of a fast-growing health-tech company transforming pharmacy care
- Work alongside a collaborative, innovative team
- Opportunity to apply your skills in a modern, tech-driven environment
- Strong potential for career growth and advancement
- Competitive benefits package for full-time employees
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients
