Job Description
Job Description
Position Overview
The Pharmacy Claims Specialist plays a key role in ensuring patients receive timely and accurate support related to their prescription benefit coverage. This role requires strong communication skills, attention to detail, and the ability to work cross-functionally within a highly collaborative healthcare operations environment.
Key Responsibilities
- Process pharmacy insurance claims accurately and in a timely manner to meet operational expectations.
- Review and triage rejected insurance claims to determine patient benefit coverage.
- Adhere to all patient assistance program guidelines and maintain compliance standards.
- Document all findings and actions according to established operating procedures.
- Conduct research using internal systems and available resources to resolve claim issues.
- Protect patient confidentiality and follow all applicable State and Federal laws.
- Perform duties in a safe and compliant manner aligned with corporate policies.
- Collaborate closely with teams across operations, pharmacy, compliance, engineering, and management.
Ideal Candidate Profile
Candidates may come from a variety of healthcare or administrative backgrounds, including:
- Pharmacy claims, insurance verification, or prior authorization experience
- Pharmacy technicians seeking a non-dispensing role
- Administrative roles within pharmacies, PBMs, health plans, or pharmaceutical organizations
- Healthcare support roles such as DME, cancer care, or other clinical environments
- High-potential candidates with strong communication and problem-solving skills, even without direct claims experience
Required Soft Skills
- Strong written and verbal communication
- Excellent technical aptitude and the ability to learn new software quickly
- Analytical mindset with sound judgment and attention to detail
- Commitment to exceptional patient care
- Ability to collaborate effectively within a team and across departments
Additional Notes for Candidates
- Candidates must disclose upcoming time-off needs; significant time off within the first 30-90 days cannot be accommodated.
- Reliable transportation is required; shuttle options may be available for certain regions.
For California Applicants:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
Company DescriptionHere at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.
Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?
Company Description
Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?