Pharmacy Benefits Specialist: Claims & Coverage Expert

SkOUT Secure Intelligence; Pittsburgh (Allegheny County); On-site; USD 42,000 - 65,000; Full time

Job summary

Oxford Solutions has an opening for a Pharmacy Benefits Specialist to join our client’s growing team. In this role, you will process pharmacy claims, search insurance coverage, and collaborate with internal teams to ensure patients receive timely and accurate support.

Full-time onsite roles in Pittsburgh, PA (Robinson) or Boise, ID with shifts between 8 AM and 9 PM EST, Monday through Friday, plus occasional Saturdays.

Qualifications

• 1 year of medical or pharmacy benefits experience
• Knowledge of Medicare Parts A, B, and D and Coordination of Benefits
• Understanding of benefit coordination, copay assistance programs, and insurance plan structures

Responsibilities

• Accurately process claims in compliance with program guidelines and client expectations
• Review and resolve rejected claims, researching patient pharmacy benefit coverage and eligibility
• Maintain compliance with patient assistance program requirements and all State and Federal regulations
• Research and document claim and benefit issues using available systems and resources
• Communicate effectively with patients, providers, and internal teams to resolve issues
• Protect the confidentiality of all patient and proprietary information
• Partner with management, compliance, and the pharmacy team to improve accuracy and workflow efficiency

Skills

Effective communication

Attention to detail

Team collaboration

Independent work

Education

High school diploma or GED

Bachelor’s degree preferred

Job description

Oxford Solutions has an opening for a Pharmacy Benefits Specialist to join our client’s growing team. In this role, you will process pharmacy claims, search insurance coverage, and collaborate with internal teams to ensure patients receive timely and accurate support.

Full-time onsite roles in Pittsburgh, PA (Robinson) or Boise, ID with shifts between 8 AM and 9 PM EST, Monday through Friday, plus occasional Saturdays.