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Pbm Analyst Jobs (NOW HIRING)

ProAct

PBM Vendor Partner Analyst

East Syracuse, NY

The PBM Vendor Partner Analyst is a member of the ProAct Partner Services reporting to the Director of Partner Services This role will be responsible for integration, configuration, testing, and ...

Alivia Health

PR · On-site

Guaynabo, PR PBM Claims Analyst is responsible for auditing, analyzing, and tracking accounts receivable related to Pharmacy Benefit Managers (PBMs) at a specialty pharmacy. This role focuses ...

Lucyrx

Financial Analyst

Bethesda, MD · On-site +1

The Financial Analyst will support PBM operations with a focus on rebate analytics, pharmacy network economics, and financial performance insights. This role collaborates with Strategic Solutions ...

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Pbm Analyst information

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$73.3K

$130K

How much do pbm analyst jobs pay per year?

As of Jun 27, 2026, the average yearly pay for pbm analyst in the United States is $73,261.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,500.00 and $87,000.00 per year, depending on experience, location, and employer.

What are some common challenges PBM Analysts face when working with large healthcare data sets?

PBM Analysts often work with complex and highly sensitive healthcare data, which can pose challenges in terms of data integrity, accuracy, and privacy. Ensuring data is consistently clean and up to date requires strong attention to detail and proficiency with analytical tools. Additionally, analysts must regularly collaborate with cross-functional teams, such as clinical staff and IT, to reconcile data discrepancies and implement effective solutions, making communication skills essential for success.

What is the difference between Pbm Analyst vs Pbm Coordinator?

AspectPbm AnalystPbm Coordinator
CredentialsTypically requires a bachelor's degree in healthcare, pharmacy, or related field; certifications like CPC or CPhT are commonSimilar educational background; may also hold certifications but often less specialized
Work EnvironmentWorks in healthcare or pharmacy benefit management companies, analyzing data and optimizing formulariesSupports daily operations, manages provider and client communications within healthcare settings
Employer & Industry UsageUsed in pharmacy benefit management, health insurance, and healthcare organizationsCommon in healthcare administration, pharmacy services, and insurance companies

The Pbm Analyst and Pbm Coordinator roles share similar educational backgrounds and work environments within healthcare and pharmacy benefit management. However, Pbm Analysts focus more on data analysis and formulary optimization, while Pbm Coordinators handle operational support and client communications. Both roles are essential in healthcare organizations but differ in their primary responsibilities.

What is a PBM Analyst?

A PBM Analyst is a professional who works within the pharmacy benefit management (PBM) industry, focusing on analyzing data related to prescription drug benefits, costs, and utilization. Their role typically involves evaluating pharmacy claims, identifying trends, and generating reports to help optimize drug benefit plans for employers, insurers, or PBM companies. PBM Analysts play a critical role in controlling costs, ensuring compliance with regulations, and improving patient outcomes by providing actionable insights based on data. They often work with cross-functional teams, including pharmacists, IT specialists, and healthcare providers. Strong analytical skills and knowledge of healthcare data and pharmacy operations are essential for this role.

What are the key skills and qualifications needed to thrive as a PBM Analyst, and why are they important?

To thrive as a PBM Analyst, you need strong analytical skills, knowledge of pharmacy benefit management processes, and a background in healthcare or pharmacy, often supported by a relevant degree. Familiarity with data analysis tools like SQL, Excel, and pharmacy claims processing systems is typically required. Attention to detail, effective communication, and problem-solving abilities help you excel in collaborating with stakeholders and interpreting complex data. These skills ensure accurate analysis, compliance, and the optimization of pharmacy benefit programs for clients and members.
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Pbm Analyst jobs near you
Principal PBM Operations Analyst

Principal PBM Operations Analyst

Blue Cross and Blue Shield of Minnesota

Eagan, MN • On-site

$102K - $138K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 22 days ago

Blue Cross Blue Shield Of Minnesota rating

5.3

Company rating: 5.3 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

253rd of 263 rated insurance

Job description

About Blue Cross and Blue Shield of Minnesota
At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.
The Impact You Will Have
The Principal PBM Operations Analyst will focus on establishing and refining operational processes related to CMS and State requirements for Medicare products. This position will develop an oversight structure of the Pharmacy Benefit Manager(s) (PBM), departmental and key stakeholder activities. This oversight structure will include the establishment of KPI's and program dashboards to measure performance.
Your Responsibilities
  • Core responsibilities will involve project management, operational management and oversight of the Pharmacy Benefit Manager(s) (PBM).
  • Build and manage dashboards for PBM oversight reporting including volume trending/analysis and quality review outcomes of key performance indicators including claims, coverage decisions and appeals, formulary, and networks. Present dashboards/reporting to Compliance Officer and Leadership, as applicable.
  • Continuously assess risk and evaluate oversight program for improvement opportunities. Define and document oversight processes, policies, and procedures for delegated pharmacy functions including those intended to identify risk and internal controls.
  • Develop enhancement strategies to existing process and technology capabilities. Manage enhancement-related projects with cross-functional teams including IT, Pharmacy, Operations, Compliance, etc.
  • Develop and manage project plans for PBM, internal stakeholder, or external vendor initiatives to ensure an accurate, timely and highly coordinated implementation.
  • Oversee PBM and Pharmacy Analyst work of Medicare PBM operational components.
  • Manage, and oversee Medicare Part D requirements and corresponding operational processes. Including, but not limited to: payment integrity - PDE/Encounter Data, FIR's, NX Transactions, and Coordination of Benefits, regulatory - implementation of guidance, audit management, regulatory reporting, CMS and DHS interactions, coverage decisions and appeals, claims. benefits, formulary/PDL, networks and materials
  • Establish PBM KPIs and Program dashboards to manage and measure outcomes related to performance guarantees.
  • Draft and maintain administrative pharmacy policies related to core job responsibilities.
  • Collaboratively work with internal and external partners, clients, and vendors.
  • Oversee intake, management, and resolution of inquiries, issues, or requests for information received from members, groups, Clients, CMS/DHS and/or any other channel.
  • This position does not have direct supervisory responsibilities but will oversee Analyst work product.

Required Skills and Experience
  • 10+ years of professional experience in pharmacy at a health plan or PBM.
  • 7+ years of project management/relationship management experience required, preferably in the pharmacy or healthcare industry preferred.
  • 5+ years of experience in triaging and resolving inquiries associated to claims and benefits.
  • 7+ years of experience working Medicare Part D
  • 5+ years of management experience (employees and/or vendor services)
  • High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience
  • Previous experience in pharmacy technician role, with or without certification
  • PBM experience preferred
  • Bachelor's degree or equivalent experience

Role Designation
Hybrid
Anchored in Connection
Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.
Compensation and Benefits
$102,400.00 - $138,300.00 - $174,200.00 Annual
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
  • Medical, dental, and vision insurance
  • Life insurance
  • 401k
  • Paid Time Off (PTO)
  • Volunteer Paid Time Off (VPTO)
  • And more

To discover more about what we have to offer, please review our benefits page.
Equal Employment Opportunity Statement
At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

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