Clinical Pharmacist: COE & RxClaim Automation Lead

Aetna; Austin (TX); Remote; USD 27,552 - 41,328; Full time

Job summary

Aetna is seeking a Clinical Pharmacist to oversee clinical operations within the COE framework and provide expert pharmaceutical guidance. The role emphasizes RxClaim adjudication, data tooling, and collaboration with internal partners to support quality and automation initiatives.

Candidates should have 3+ years in clinical operations and RxClaim coding, a pharmacist license, and willingness to travel 10-23%. Bachelor’s degree in Pharmacy or PharmD is required.

Qualifications

• 3+ years of clinical operations experience.
• 3+ years of RxClaim adjudication coding.
• 3+ years of direct customer-facing work in specialty gain.
• Willingness to travel 10–23%.
• Active pharmacist license in home state.

Responsibilities

• Provide oversight for clinical components within COE and offer scientific guidance.
• Collaborate with pharmacists, advisors, and partners on quality and automation tasks.
• Ensure compliance and quality of claims processed in RxClaim.
• Offer clinical judgment and suggest process improvements for COE initiatives.
• Analyze trends and support IT and automation projects.
• Engage with internal partners via calls and conferences as needed.

Skills

Clinical operations experience

RxClaim adjudication

Customer-facing experience

Travel willingness

Pharmacist license

Education

Bachelor’s degree in Pharmacy or PharmD

Tools

Excel

Microsoft Access

Job description

Aetna is seeking a Clinical Pharmacist to oversee clinical operations within the COE framework and provide expert pharmaceutical guidance. The role emphasizes RxClaim adjudication, data tooling, and collaboration with internal partners to support quality and automation initiatives.

Candidates should have 3+ years in clinical operations and RxClaim coding, a pharmacist license, and willingness to travel 10-23%. Bachelor’s degree in Pharmacy or PharmD is required.