Remote Oncology Pharmacy Claims Adjudication Specialist

TQC Ltd

Denver (CO)

Hybrid

USD 33,000 - 39,000

Full time

14 days+

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Benefits offered by this job

Medical, Dental, Vision

401k with match

PTO and Holidays

Tuition Reimbursement

Company paid life and disability

Job summary

Onco360 Pharmacy in the Mountain Time Zone is seeking a Pharmacy Adjudication Specialist for a full-time remote/hybrid role. The position requires active Colorado Pharmacy Technician credentials and offers starting pay of $24.00 per hour, plus a $5,000 sign-on bonus for hires before August 31, 2026.

Key duties include adjudicating pharmacy claims, resolving third-party rejections, ensuring COB accuracy, and communicating delays to patients to support timely delivery.

Qualifications

2+ years experience in Pharmacy/Healthcare or pharmacy claims
Pharmacy claims adjudication and COB knowledge
Knowledge of Medicare/Medicaid and commercial insurance
Ability to resolve third-party rejections
Attention to detail and data accuracy

Responsibilities

Adjudicate pharmacy claims for active workflows
Resolve third-party rejections and obtain overrides
Ensure accurate patient setup in CPR+ system
Communicate delays to patients/providers regarding claims
Support timely shipment and COB application

Skills

Pharmacy claims adjudication

Coordination of benefits

NCPDP claim resolution

Medicare/Medicaid/Commercial insurance

PBM contracts knowledge

Pharmacy terminology & dosages

CPR+ data entry

Customer service mindset

Education

High School Diploma or GED

Certified Pharmacy Technician (PTCB)

Job description

Key duties include adjudicating pharmacy claims, resolving third-party rejections, ensuring COB accuracy, and communicating delays to patients to support timely delivery.

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