Pharmacy Pricing Appeals Specialist (PBM Claims)

Socket.dev; Charlotte (NC); Hybrid; USD 32,000 - 39,000; Full time

Job summary

Judi Health in Charlotte, NC is seeking a Pharmacy Pricing Appeals Analyst to handle end-to-end intake, review, investigation, and processing of pharmacy pricing appeals. You will validate appeals, research claims, review invoices, and document decisions to ensure timely, accurate resolutions.

You will collaborate with the Manager of Pharmacy Pricing Appeals and cross-functional teams, requiring meticulous attention to detail and knowledge of PBM and reimbursement concepts.

Qualifications

• 2–4 years of PBM, pharmacy operations or healthcare claims experience.
• Associates Degree preferred; equivalent combination of education and pharmacy/PBM experience may be considered.
• Direct experience researching, validating, or resolving pharmacy claims.
• Experience reviewing pharmacy claim data, adjudication results, Rx numbers, NDCs, and pharmacy identifiers.
• Experience with claims tracking tools, workflow tickets, spreadsheets, and operational documentation.
• Working knowledge of pharmacy reimbursement concepts and PBM claims processes.
• Intermediate to advanced Excel skills for data entry, filtering, sorting and templates.

Responsibilities

• Claims Investigation – Research pharmacy claim details, validate identifiers and document findings.
• Analytical Thinking – Compare pharmacy claim payment data against invoice and acquisition cost.
• Pharmacy Claims Knowledge – Understand PBM and pharmacy claims terminology, adjudication, and reimbursement concepts.
• Communication – Clear written and verbal communication with internal stakeholders and pharmacy contacts.
• Data Integrity – Maintain accurate, complete and audit-ready records.

Skills

PBM experience

Pharmacy operations

Pharmacy claims

Pharmacy reimbursement

Network operations

Healthcare claims

Excel advanced

Education

Associate degree preferred

Tools

Spreadsheets

Claims tracking tools

Workflow tickets

Job description

Judi Health in Charlotte, NC is seeking a Pharmacy Pricing Appeals Analyst to handle end-to-end intake, review, investigation, and processing of pharmacy pricing appeals. You will validate appeals, research claims, review invoices, and document decisions to ensure timely, accurate resolutions.

You will collaborate with the Manager of Pharmacy Pricing Appeals and cross-functional teams, requiring meticulous attention to detail and knowledge of PBM and reimbursement concepts.