Pharmacy Claims Lead — Operations & Payments

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

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.