Pharmacy Claims Adjudication Specialist

About the role

Full-time hybrid position at a specialty pharmacy in Louisville, Kentucky. The specialist adjudicates pharmacy claims, resolves insurance rejections, coordinates benefits, verifies patient and insurance information, and communicates with patients and providers about claims and medication delivery delays. Shifts are scheduled between 8 a.m. and 8 p.m.

What you'll do

• Adjudicate primary, secondary, and tertiary pharmacy claims and review responses for accuracy
• Resolve third-party claim rejections and obtain overrides when appropriate
• Maintain accurate patient demographic and insurance information in the CPR+ system
• Contact insurers, patients, and providers regarding claims and medication delivery delays
• Verify eligibility for copay cards and manage funding-related adjudications
• Reconcile prescription delivery assessments and collect copayments before shipment
• Document patient refund requests and maintain patient confidentiality
• Comply with pharmacy procedures, professional standards, and applicable laws

What you'll bring

• High school diploma or GED
• At least 2 years of experience in a pharmacy or healthcare setting or with pharmacy claims
• Knowledge of pharmacy and NDC billing, claims resolution, PBM and medical contracts, Medicare, Medicaid, commercial insurance, NCPDP rejections, and coordination of benefits
• Knowledge of pharmacy terminology and medication brand and generic names
• Basic mathematical, analytical, typing, and keyboarding skills
• Registration with the Board of Pharmacy where required by state law
• Strong written and verbal communication, organization, time-management, and interpersonal skills
• Ability to work independently, meet deadlines, and maintain attention to detail

Benefits

• 5000 sign-on bonus for eligible employees starting before October 31, 2026
• Medical, dental, and vision insurance
• 401(k) with company match
• Paid time off and paid holidays
• Tuition reimbursement
• Company-paid life insurance
• Company-paid short-term and long-term disability insurance