Pharmacy Adjudication Supervisor — Lead Claims Team

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

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401k with match

Paid Time Off and Holidays

Quarterly Incentive Bonuses

Tuition Reimbursement

Life Insurance

Disability (short/long-term)

Job summary

Onco360 Pharmacy seeks a Pharmacy Adjudication Supervisor to lead the adjudication team and ensure accurate pharmacy claims processing for a growing specialty program.

The role involves resolving third-party rejections, coordinating benefits, and outreach to patients when delivery is delayed due to insurance issues. A strong background in insurance, claims, and PBM contracts is required.

Qualifications

• Required: High School Diploma or GED; knowledge of insurance regulations.
• Desired: Associates or Bachelor’s Degree; Certified Pharmacy Technician; Specialty pharmacy experience.

Responsibilities

• Supervise adjudication staff and maintain a positive working environment.
• Assist in day-to-day pharmacy operations and implement procedures for accurate dispensing.
• Recruit, hire, train, and coach staff; manage performance and corrective actions as needed.
• Oversee daily activity and workflow; monitor Pulse reporting and team output.
• Handle escalations for complex claim rejection resolutions and ensure timely shipments.

Skills

NDC billing

PBM contracts

Medicare/Medicaid knowledge

NCPDP rejection resolution

Coordination of benefits

Interpersonal skills

Pharmacy terminology

Education

High School Diploma or GED

Associates or Bachelor's Degree

Certified Pharmacy Technician

Specialty pharmacy experience

Job description

Onco360 Pharmacy seeks a Pharmacy Adjudication Supervisor to lead the adjudication team and ensure accurate pharmacy claims processing for a growing specialty program.

The role involves resolving third-party rejections, coordinating benefits, and outreach to patients when delivery is delayed due to insurance issues. A strong background in insurance, claims, and PBM contracts is required.