Pharmacy Benefits /Insurance Claims Specialist | Onsite- Pittsburgh

Pittsburgh · Chesterfield · Onsite · Posted Sep 29, 2026

At a glance

The Pharmacy Benefits / Insurance Claims Specialist processes pharmacy claims and triages rejected insurance claims to determine patient coverage.
This role requires working cross-functionally with management, pharmacy, compliance, and engineering teams to ensure accurate and compliant claim processing.

Process pharmacy claims accurately and timely to meet client expectations
Triage rejected pharmacy insurance claims to ascertain patient pharmacy benefits coverage
Maintain compliance with patient assistance program guidelines
Document all information and data discovery according to operating procedures
Research required information using available resources
Maintain confidentiality of patient and proprietary information
Perform all tasks in a safe and compliant manner consistent with corporate policies and State and Federal laws
Work collaboratively and cross-functionally between management, the Missouri-based pharmacy, compliance and engineering

High school diploma or GED
One year of Pharmacy Experience, having resolved third party claims
Healthcare industry experience with claims background
Strong verbal and written communication skills
Attention to detail and a strong operational focus
Passion for providing top-notch patient care
Ability to work with peers in a team effort and cross-functionally
Strong technical aptitude and ability to learn complex new software
Must hold all active licenses and registrations required for the role under applicable state law

Health, Dental & Vision insurance with multiple plan options from day 1
Employee Assistance Program with counseling, wellness coaching, and legal/financial advice
Life & Disability Insurance
Free onsite parking
Pre-tax commuter FSA
Free shuttle service
Free snacks and drinks