Remote Pharmacy Claims Specialist — Growth & Flex

Pharmerica; Louisville (KY); Remote; USD 42,000 - 66,000; Full time

Benefits offered by this job

DailyPay

Flexible Schedules

Competitive Pay with Shift Differenti

Health, Dental, Vision, and Life Ins

Company-Paid Disability Insurance

Tuition Assistance & Reimbursement

Employee Discount Program

401k Plan

Paid Time Off

Non-Retail, Closed-Door Environment

Job summary

PharMerica is seeking a Claims Specialist for a 100% remote role focusing on third-party pharmacy claims. The ideal candidate will have a background in pharmacy claims or adjudication and a strong customer service orientation to support long-term care and senior living clients.

The role emphasizes accurate claims processing, timely reimbursement, and collaboration with Medicare D plans and Medicaid. A non-retail, closed-door environment is highlighted to enable focused work in claims and

Qualifications

• Requires a High School Diploma or GED.
• Associates or Bachelor’s degree preferred.
• Experience in customer service and pharmacy claims is preferred.

Responsibilities

• Manages and resolves rejected pharmacy claims to maximize payer reimbursement.
• Researches and resolves claims with Medicare D plans, third-party insurers, and state Medicaid to maximize reimbursement.
• Ensures claim approvals by applying edits and reversals.
• Monitors revenue at risk from payer setup, billing, rebilling and reversal processes.
• Collaborates with team to document payer/billing trends and issues.
• Prepares reports and maintains records for processing.
• Performs other tasks as assigned.

Skills

Customer Service

Basic math aptitude

Microsoft Office Suite

Fast-paced environment

Education

High School Diploma or GED

Associate’s or Bachelor’s Degree (desired)

Tools

Microsoft Office Suite

Job description

PharMerica is seeking a Claims Specialist for a 100% remote role focusing on third-party pharmacy claims. The ideal candidate will have a background in pharmacy claims or adjudication and a strong customer service orientation to support long-term care and senior living clients.

The role emphasizes accurate claims processing, timely reimbursement, and collaboration with Medicare D plans and Medicaid. A non-retail, closed-door environment is highlighted to enable focused work in claims and