Pharmacy Benefits Specialist

ADP, Inc.; Town of Florida (NY); On-site; USD 52,000 - 62,000; Full time

Job summary

ADP, Inc. is seeking a Reimbursement Specialist to research and investigate drug or treatment benefit coverage for MD offices. You will handle benefit investigations, update claim details, and communicate results to case management.

The role requires 1–2 years in pharmacy or insurance verification, strong customer service, and HIPAA awareness. A two-year degree or equivalent in healthcare is preferred; you will work closely with the Program Manager and Case Manager.

Qualifications

• Requires 1–2 years in pharmacy or insurance verification.
• Experience in pharmacy benefit investigation and adjudication.
• Associate's degree or equivalent in healthcare preferred; high school diploma required.
• Strong customer service and communication skills.
• HIPAA confidentiality maintained.

Responsibilities

• Handle benefit request investigations via test claim, eBV or phone.
• Contact insurance companies to obtain patient benefits.
• Update claim processing information in the patient record (BIN, PCN, ID, Group).
• Document detailed pharmacy benefit results with appropriate information.
• Identify and escalate priority issues to the Case Manager or Program Manager.
• Follow up on Prior authorization status per business rules.
• Document all call information according to procedures.
• Review referrals for information accuracy and completeness.
• Perform other duties as assigned by the Program Manager or Team Lead.

Skills

Pharmacy knowledge

Insurance verification

Customer service

Data entry

Call center

HIPAA compliance

Education

Associate's degree or equivalent in healthcare

High School Diploma or GED

Job description

ADP, Inc. is seeking a Reimbursement Specialist to research and investigate drug or treatment benefit coverage for MD offices. You will handle benefit investigations, update claim details, and communicate results to case management.

The role requires 1–2 years in pharmacy or insurance verification, strong customer service, and HIPAA awareness. A two-year degree or equivalent in healthcare is preferred; you will work closely with the Program Manager and Case Manager.