Senior Pharmacy Claims Adjudication Lead

Onco360; Houston (TX); On-site; USD 54,000 - 66,000; Full time

Benefits offered by this job

Medical; Dental; Vision

401k with a match

Paid Time Off and Paid Holidays

Quarterly Incentive Bonuses

Tuition Reimbursement

Company paid benefits - life insurance

Job summary

Onco360 Pharmacy is hiring a Pharmacy Adjudication Supervisor in Houston, TX. This full-time role runs Monday through Friday, 9:30 am–6:00 pm CST. You will oversee adjudication staff, ensure accuracy, and manage third-party claim resolutions to support timely medication delivery.

Join a team dedicated to oncology and complex medication management. We seek candidates with pharmacy adjudication experience, leadership ability, and strong communication skills to drive operational excellence.

Qualifications

• High School Diploma or GED and pharmacy adjudication experience.
• Associates or Bachelor's degree preferred; certification desirable.
• Experience with specialty pharmacy operations is a plus.

Responsibilities

• Supervise adjudication staff to maintain positive teamwork and productivity.
• Assist Director of Pharmacy Operations in day-to-day operations and new procedures.
• Recruit, hire, orient, train, and coach staff; implement corrective actions as needed.
• Monitor daily workflow and Pulse reporting; manage staff performance.
• Resolve escalations for complex claim rejection cases to ensure timely completion.
• Adjudicate pharmacy claims and verify accuracy before acceptance; contact insurers.
• Manage prior authorizations and document information in patient profiles.
• Ensure compliance with laws, policies, and privacy standards.

Skills

NDC medication billing

PBM and medical contracts

Medicare/Medicaid/Commercial insurance

NCPDP claim rejection resolution

Coordination of benefits

Interpersonal skills

Pharmacy terminology

Education

High School Diploma or GED

Associates or Bachelor's Degree

Certified Pharmacy Technician

Specialty pharmacy experience

Job description

Onco360 Pharmacy is hiring a Pharmacy Adjudication Supervisor in Houston, TX. This full-time role runs Monday through Friday, 9:30 am–6:00 pm CST. You will oversee adjudication staff, ensure accuracy, and manage third-party claim resolutions to support timely medication delivery.

Join a team dedicated to oncology and complex medication management. We seek candidates with pharmacy adjudication experience, leadership ability, and strong communication skills to drive operational excellence.