Pharmacy Claims Lead — Payments & Ops Champion

Rippling, Inc.; Pittsburgh (Allegheny County); On-site; USD 90,000 - 125,000; Full time

Benefits offered by this job

Generous PTO

100% employer-paid medical, dental, &

Employer HSA contribution

Paid parental leave

401(k) match

Transportation and parking benefits

Flexible, collaborative work

Job summary

Free Market Health is seeking a Claims Analyst Lead to ensure accurate, reliable claims processing across medical and pharmacy claims. You will lead escalated issue resolution, partner with multiple teams, and drive workflow improvements to support timely payments and strong partner outcomes.

You will collaborate with Pharmacy Services, Client Services, Finance, Technology Services, and external payer/pharmacy partners to diagnose root causes and scale operations.

Qualifications

• 4+ years in pharmacy/healthcare operations with claims experience.
• Strong knowledge of medical and pharmacy claims workflows.
• Familiarity with industry standards such as NCPDP, X12.
• Proficiency with Microsoft Office; SQL knowledge.

Responsibilities

• Lead resolution of escalated claim payment issues across medical and pharmacy claims.
• Oversee medical claims clearinghouse operations and support high-quality processing.
• Partner with Technology Services to diagnose issues impacting claims processing.
• Collaborate across teams to improve workflows and automation for payment accuracy.
• Identify and resolve systemic payment issues related to payer configurations.
• Coordinate with payer clients on claim reconciliation and payment issue resolution.
• Support payer and pharmacy partners with claim submissions and onboarding.
• Develop structured processes, such as rebill cycles, to correct errors.

Job description

Free Market Health is seeking a Claims Analyst Lead to ensure accurate, reliable claims processing across medical and pharmacy claims. You will lead escalated issue resolution, partner with multiple teams, and drive workflow improvements to support timely payments and strong partner outcomes.

You will collaborate with Pharmacy Services, Client Services, Finance, Technology Services, and external payer/pharmacy partners to diagnose root causes and scale operations.