Pharmacy Claims & Benefits Specialist (Remote)

Our client is seeking an experienced Pharmacy Claims & Benefits Specialist to support members, providers, and insurance carriers by verifying eligibility, resolving prescription issues, and ensuring accurate claims processing in a fast-paced pharmacy environment.

Schedule

• Monday – Friday | 11:30 AM – 8:00 PM
• Occasional Saturdays & required overtime
• Remote role with potential 1–2 days onsite ( Plymouth MI, Tempe, AZ or North Canton, OH)

Key Responsibilities

• Verify insurance eligibility and prescription benefits
• Process prescriptions and support claims adjudication
• Communicate with providers, payers, pharmacies, and members to resolve billing or prescription issues
• Coordinate with PBMs and pharmacists
• Maintain accurate documentation and meet productivity/quality goals
• Escalate complex issues as needed

Qualifications

• Must reside within 45 miles of Plymouth MI, Tempe, AZ or North Canton, OH
• High School Diploma required; degree preferred
• Active State Pharmacy Technician license (in Michigan or Ohio)
• National certification (PTCB or NHA)
• 1-2 years of pharmacy experience
• Experience with claims adjudication, Medicaid, secondary billing, or discount cards preferred
• Strong communication, attention to detail, and ability to work in a high-volume environment
• Proficiency in Microsoft Office and pharmacy systems

Pay: $20.50 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Referral program

Work Location: Hybrid remote in Plymouth, MI 48170