Pharmacy Adjudication Supervisor – Lead Claims & Rejections

Onco360; Waltham (MA); On-site; USD 54,000 - 66,000; Full time

Benefits offered by this job

401k with a match

Paid Time Off

Paid Holidays

Quarterly Incentive Bonuses

Tuition Reimbursement

Company paid benefits – life insurance

Job summary

Onco360 Pharmacy in Waltham, MA is seeking a Pharmacy Adjudication Supervisor for a full-time role (Mon-Fri, 9:30 am–6:00 pm EST). You will oversee claims adjudication, minimize third-party rejections, and coordinate benefits to ensure timely medication delivery.

The position requires strong knowledge of NDC billing, PBM contracts, and Medicare/Medicaid rules, with leadership duties to coach staff and optimize workflows. Salary starts at $60k with a $5k sign-on bonus for qualifying candidates.

Qualifications

• Required: High School Diploma or GED; experience in Pharmacy, Medical Billing, or Benefits Verification; knowledge of insurance and applicable regulations
• Desired: Associates or Bachelor’s Degree; Certified Pharmacy Technician; Specialty pharmacy experience
• Required: 4+ years in pharmacy or pharmacy adjudication or equivalent experience; leadership experience
• Desired: 5+ years in pharmacy or adjudication; 1+ years supervisor experience; specialty pharmacy experience
• Required: Independent worker with leadership; strong communication and organization; detail-oriented and able to meet deadlines

Responsibilities

• Supervises adjudication staff in a leadership role to maintain a positive working environment
• Assists Director of Pharmacy Operations in day-to-day pharmacy operations
• Works with management to recruit, hire, orientate, develop, and train associates; delivers corrective action plans
• Manages daily activity of team members and reports on workflow
• Handles escalations for difficult claim rejection resolution cases
• Adjudicates pharmacy claims in active workflow and reviews claim responses for accuracy
• Contacts insurance companies to resolve third-party rejections and reschedule deliveries if needed
• Documents prior authorization information in patient profiles
• Maintains compliance with laws, policies, and ethics
• Contributes to team effort and other duties as assigned

Skills

NDC billing

PBM contracts

Medicare knowledge

Coordination of benefits

Interpersonal skills

Leadership

Typing/math/analytical

Education

High School Diploma or GED

Associates or Bachelor’s Degree

Certified Pharmacy Technician

Job description

Onco360 Pharmacy in Waltham, MA is seeking a Pharmacy Adjudication Supervisor for a full-time role (Mon-Fri, 9:30 am–6:00 pm EST). You will oversee claims adjudication, minimize third-party rejections, and coordinate benefits to ensure timely medication delivery.

The position requires strong knowledge of NDC billing, PBM contracts, and Medicare/Medicaid rules, with leadership duties to coach staff and optimize workflows. Salary starts at $60k with a $5k sign-on bonus for qualifying candidates.