Specialty Pharmacy Adjudication Supervisor - Lead Claims Team

Onco360 Oncology Pharmacy; Waltham (MA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

401k with match

Paid Time Off

Paid Holidays

Quarterly Incentive Bonuses

Tuition Reimbursement

Company paid life insurance

Short and long-term disability

Job summary

Onco360 Pharmacy is seeking a Pharmacy Adjudication Supervisor to lead a claims adjudication team in a fast-paced oncology specialty pharmacy. This full-time role in Waltham, MA focuses on ensuring accurate adjudication, reducing claim rejections, and maintaining timely medication shipping.

The ideal candidate has 4+ years in pharmacy adjudication with leadership experience, strong knowledge of PBM contracts and insurance, and excellent communication skills.

Qualifications

• High School Diploma or GED required.
• 4+ years in pharmacy adjudication or equivalent experience; leadership preferred.
• Knowledge of insurance, Medicare, Medicaid and commercial plans.
• Strong interpersonal and communication skills; detail-oriented and analytical.
• Pharmacy terminology and codes; familiarity with NCPDP claim processes.

Responsibilities

• Supervise adjudication staff and maintain a positive, productive environment.
• Assist Director of Pharmacy Operations in day-to-day operations and new procedures.
• Recruit, train, and evaluate staff; implement corrective actions as needed.
• Monitor daily workflow and report on team performance (Pulse reporting).
• Handle escalations for difficult claim rejections and ensure timely adjudication.
• Adjudicate claims for active prescriptions across primary, secondary, and tertiary plans.
• Contact insurers to resolve rejections and reschedule deliveries if needed.
• Coordinate with management on projects and initiatives; ensure regulatory compliance.

Skills

NDC billing

PBM contracts

Medicare knowledge

Insurance knowledge

Interpersonal skills

Leadership

Education

High School Diploma or GED

Associates or Bachelor's Degree

Certified Pharmacy Technician

Specialty pharmacy experience

Job description

Onco360 Pharmacy is seeking a Pharmacy Adjudication Supervisor to lead a claims adjudication team in a fast-paced oncology specialty pharmacy. This full-time role in Waltham, MA focuses on ensuring accurate adjudication, reducing claim rejections, and maintaining timely medication shipping.

The ideal candidate has 4+ years in pharmacy adjudication with leadership experience, strong knowledge of PBM contracts and insurance, and excellent communication skills.