Pharmacy Services Specialist

Job overview

The Pharmacy Services Specialist role is remote across the United States. Pay is $21–$23 per hour. The position supports pharmacy benefit management operations for a client in the health insurance industry. The specialist coordinates benefit administration, resolves escalated service and claims issues, and works with clinical, appeals, account, and external partner teams. This work supports accurate pharmacy coverage decisions and responsive plan administration.

What you'll do

• Coordinate daily pharmacy benefit management activities
• support research, development, implementation, and evaluation of programs
• serve as a resource for pharmacy initiatives
• resolve or escalate issues involving clinical and contractual matters
• oversee benefit-plan administration quality assurance
• address escalated customer inquiries and grievances, including claim adjustments
• coordinate coverage determinations, claim reconsiderations, appeals, RFP reviews, and government program applications.

What we're looking for

Skills & competencies

pharmacy services specialist

remote

pyramid consulting

pharmacy benefit management

pbm

claims management

coverage determinations

appeals

customer service

health insurance

$21–$23/hour

six-month-plus opportunity

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, dental, and vision insurance
• 401(k)
• paid sick leave, depending on work location.

Why this role

The posting describes a six-month-plus contract opportunity with long-term potential and requires three or more years of related experience, including strong PBM and claims management experience.

About the employer

Pyramid Consulting, Inc is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.