Pharmacy Claims Lead

Free Market Health; Pittsburgh (Allegheny County); On-site; USD 90,000 - 125,000; Full time

Benefits offered by this job

Generous PTO

Full health coverage

HSA contribution

Parental leave

401(k) match

Transit/ Parking benefits

Flexible work environment

Job summary

Free Market Health in Pittsburgh is seeking a Pharmacy Claims Lead to ensure accurate, efficient processing of medical and pharmacy claims. You will resolve escalated payment issues, coordinate with cross-functional teams, and drive improvements in workflows and automation.

The role reports to the Director, Claims Support and is based in Pittsburgh, PA. Ideal candidates have 4+ years in pharmacy/healthcare claims and strong knowledge of NCPDP/X12, SQL, and MS Office.

Qualifications

• 4+ years in pharmacy, healthcare, or related ops environment with claims experience.
• Understand medical and pharmacy claims workflows and processes.
• Familiar with data standards like NCPDP and X12; strong Excel/Office skills.

Responsibilities

• Lead resolution of escalated claim payment issues across medical and pharmacy claims.
• Oversee medical claims clearinghouse operations and ensure high-quality processing.
• Collaborate with Tech Services and Engineering to diagnose and fix system issues.

Skills

Pharmacy claims

Healthcare operations

NCPDP

X12

SQL

Microsoft Office

Cross-functional collaboration

Attention to detail

Tools

SQL

Excel

XML/JSON

Job description

Pharmacy Claims Lead

Free Market Health Pittsburgh, Pennsylvania, United States

About this position

Why FMH
Every day, someone receives a life-changing diagnosis. Getting the right medication should be straightforward - but too often it isn’t.

Specialty medications move through a complex network of providers, health plans, pharmacies, and manufacturers. Administrative delays, disconnected systems, and limited visibility can slow treatment when time matters most.

Free Market Health exists to make that process work better.

Our technology connects stakeholders across the specialty pharmacy ecosystem, helping prescriptions reach the right pharmacy while improving visibility, reducing friction, and keeping treatment moving forward for the patients who depend on them. We focus on the most important stakeholder of all: the patient.

Your impact

Free Market Health is seeking a Claims Analyst Lead to review and ensure the accuracy, reliability, and efficiency of healthcare claims processing across medical and pharmacy claims. This role is ideal for someone who enjoys solving complex operational issues, partnering across teams, and improving processes that directly support timely, accurate payments and strong partner outcomes. This position will be the team's go to Claims subject matter expert and will report directly to the Director, Claims Support.

In this role, you will serve as a key operational resource for escalated claims issues, clearinghouse support, payment reconciliation, and workflow improvement. You will collaborate closely with teams across Pharmacy Services, Client Services, Finance, Technology Services, Software Engineering, and external payer and pharmacy partners to resolve issues, identify root causes, and support scalable claims operations.

What You'll Do

• Lead resolution of escalated claim payment issues across medical and pharmacy claims, ensuring timely, accurate outcomes.
• Oversee medical claims clearinghouse operations and support consistent, high-quality claims processing.
• Partner with Technology Services and Software Engineering to diagnose and resolve technical issues impacting claims processing and system performance.
• Collaborate cross-functionally with Referral Support, Intake Support, Pharmacy Services, Client Services, and Finance to improve workflows, enhance automation, and support payment accuracy.
• Identify and resolve systemic payment issues related to payer or PBM configuration, addressing root causes and preventing recurrence.
• Coordinate with payer clients on claim reconciliation and payment issue resolution to support financial accuracy and partner satisfaction.
• Support payer and pharmacy partners with claim submission processes, onboarding, and ongoing operational needs.
• Develop and manage structured processes, such as rebill cycles, to correct claims paid at incorrect rates and improve operational consistency.

What We're Looking For

• A minimum of 4 years of experience in pharmacy, healthcare, operations, or a related environment, with hands-on involvement in healthcare claims or related transactions.
• Strong understanding of medical and pharmacy claims workflows and operational processes.
• Familiarity with industry standards and formats such as NCPDP, X12, or similar healthcare data standards.
• Proficiency with Microsoft Office applications and working knowledge of SQL.
• Strong communication, organization, problem-solving, and attention to detail.
• Ability to work cross-functionally, evaluate complex issues, and drive practical operational solutions.

Nice to Haves

• Experience with FHIR, XML, JSON, or other healthcare data formats.

Life at FMH

We're building more than a company. We're building a team of ambitious, curious people who are passionate about solving meaningful problems, growing their careers, and genuinely enjoying the journey together.

Based in Pittsburgh's Strip District, FMH draws inspiration from the city we call home. Our value of Grit isn't just a word on a wall. It's a mindset inspired by the city around us: showing up, rolling up our sleeves, and finding a way forward no matter the challenge.

As FMH continues to grow, so do the opportunities for our people to leave their mark. Guided by our core values of Integrity, Adaptability, Grit, and Collaboration, we foster an environment where trust is earned, new ideas are welcomed, challenges are embraced, and success is shared. You will be surrounded by people who care deeply about the work they do and the people they do it with.

Together, we're building something special, and we're just getting started.

• Generous PTO
• 100% employer-paid individual medical, dental, and vision premiums
• Employer HSA contribution
• Paid parental leave
• 401(k) match
• Transportation and parking benefits
• Flexible, collaborative work environment

Benefit eligibility is based on employment status.

Build What's Next With Us

Healthcare is evolving - and so are we.

If you're excited by meaningful challenges, collaborative teammates, and the opportunity to help build a growing healthcare technology company, we'd love to hear from you.

Equal Opportunity Employer

Free Market Health is proud to be an Equal Opportunity Employer.

We believe that a diverse and inclusive workplace makes us better teammates and problem solvers and we encourage all qualified individuals to apply. Employment decisions are based on business needs, qualifications, and merit.

FMH is also committed to providing reasonable accommodations throughout the hiring process. If you require assistance or accommodation due to a disability, we will work with you to meet your needs.