Hybrid Pharmacy Claims Adjudication Specialist

Onco360 Oncology Pharmacy; Waltham (MA); Hybrid; USD 54,000 - 75,000; Full time

Benefits offered by this job

Medical; Dental; Vision

401k with a match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Company paid benefits – life; andshort

and long-term disability

Job summary

Onco360 Oncology Pharmacy in Waltham, MA, seeks a Pharmacy Adjudication Specialist for a hybrid, full-time role. Shifts span 8am–8pm, with a starting salary from $26.00 per hour and a $5,000 sign-on bonus for those starting before Dec 31, 2026.

Key duties include adjudicating claims, resolving third-party rejections, and coordinating benefits for accurate shipments while maintaining patient confidentiality and compliance.

Qualifications

• High school diploma or GED required; pharmacy/healthcare exposure preferred.
• Associate degree or equivalent program is a plus; pharmacy tech certification desired.
• Knowledge of pharmacy terminology, claims adjudication, and insurance contracts.

Responsibilities

• Adjudicate pharmacy claims and review responses for accuracy.
• Resolve third-party rejections and obtain overrides when appropriate.
• Notify patients about delays due to insurance claims and reschedule deliveries.
• Ensure patient setup in CPR+ with demographics and insurance data.
• Communicate with insurers to resolve COB/benefit issues.
• Assist with reconciliations and copay management prior to shipment.
• Provide customer service liaison on financial responsibility before shipments.

Skills

Pharmacy billing

Claims adjudication

COB/BOB knowledge

PBM contracts

Medicare/Medicaid knowledge

NCPDP rejection resolution

Insurance coordination

Data entry/compliance

Education

High School Diploma or GED

Associate degree or equivalent program

Tools

CPR+ system

Job description

Onco360 Oncology Pharmacy in Waltham, MA, seeks a Pharmacy Adjudication Specialist for a hybrid, full-time role. Shifts span 8am–8pm, with a starting salary from $26.00 per hour and a $5,000 sign-on bonus for those starting before Dec 31, 2026.

Key duties include adjudicating claims, resolving third-party rejections, and coordinating benefits for accurate shipments while maintaining patient confidentiality and compliance.